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Hur Y, Ahn JM, Kim HJ, Jeon Y, Kang Y, Gong HS. Peripheral tear of the triangular fibrocartilage complex: diagnostic accuracy of magnetic resonance imaging and diagnostic performance of the primary and secondary signs. Skeletal Radiol 2024; 53:1153-1163. [PMID: 38127153 DOI: 10.1007/s00256-023-04517-y] [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: 09/12/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study is to assess the diagnostic performance of magnetic resonance imaging (MRI) findings for type 1B triangular fibrocartilage complex (TFCC) tear of the wrist. MATERIALS AND METHODS This study retrospectively enrolled 78 patients to examine the diagnostic performance of preoperative MRI examinations in patients with type 1B TFCC tears. Thirty-nine participants had confirmed type 1B TFCC tear. The control group included 39 patients who were randomly selected from 1157 patients who underwent MRI for wrist pain. Both groups underwent a review of 19 MRI findings by two independent radiologists, and the correlation between each diagnostic finding and type 1B TFCC tear was assessed using the chi-squared test. The 19 MRI findings comprised eight primary signs of abnormalities in the distal or proximal lamina, in conjunction with 11 secondary signs suggestive of abnormalities in the surrounding structures. RESULTS The TFCC tear group demonstrated a significantly higher incidence of two primary MRI signs, i.e., fiber discontinuity and signal alteration in the distal lamina, as observed by both readers (R1, 74.4% vs. 38.5%, p = 0.003, and 87.2% vs. 43.6%, p < 0.001; R2, 74.4% vs. 35.9%, p = 0.001, and 87.2% vs. 53.8%, p < 0.003, respectively). Reader 2 identified a higher prevalence of two additional primary MRI signs: fiber discontinuity and signal alteration in the proximal lamina (all p < 0.05). None of the 11 secondary MRI signs demonstrated statistically significant associations with type 1B TFCC. CONCLUSION MRI manifestations of fiber discontinuity and signal alteration in the distal lamina may provide predictive markers for type 1B TFCC wrist tear.
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Affiliation(s)
- Youngjun Hur
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yejin Jeon
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Lee J, Ahn JM, Kim BR, Kang Y, Lee E, Lee JW, Kang HS. MR evaluation of the posteromedial corner of the knee: association of posterior horn medial meniscus tear with posterior oblique ligament and distal semi-membranosus tendon tear. Br J Radiol 2023; 96:20220944. [PMID: 36924261 DOI: 10.1259/bjr.20220944] [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: 03/18/2023] Open
Abstract
OBJECTIVE To assess if posterior oblique ligament and distal semi-membranosus tendon tears are associated with posterior horn medial meniscus tears on MRI. METHODS From January 1, 2018 to December 31, 2019, 56 patients who met the inclusion criteria were enrolled in this study. Of the 56 patients, 43 patients who had a posterior horn of medial meniscus tear were included in the study group. A control group of 13 individuals was formed for comparison. Two radiologists reviewed the MR images and recorded the presence and grades of posterior oblique ligament and distal semi-membranosus tendon tears. We used the independent t-test and one-way ANOVA to compare the tear grades. Interobserver agreement was analyzed using a Cohen's κ coefficient (κ value) for categorical variables. RESULTS The mean grades for the posterior oblique ligament and distal semi-membranosus tendon tears were significantly higher in the study group (all, p < 0.001). Interobserver agreement between the two readers was substantial in assessing the grade of posterior oblique ligament tear (κ = 0.653±0.087) and almost perfect in assessing the grade of distal semi-membranosus tendon tear (κ = 0.876±0.060). CONCLUSION Posterior oblique ligament and distal semi-membranosus tendon tears are significantly associated with posterior horn of medial meniscus tear and medial meniscus posterior root tears, and the peel-back mechanism could be related to this association. ADVANCES IN KNOWLEDGE Presenting this paper could adjust radiologist search patterns and potentially help orthopedists with management and pre-surgical planning for the posteromedial corner injury of the knee.
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Affiliation(s)
- Jaehyung Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bo Ram Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Kim KW, Lee CH, Choi JH, Ahn JM, Gong HS. Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture? Arch Orthop Trauma Surg 2023; 143:839-845. [PMID: 34618191 DOI: 10.1007/s00402-021-04199-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies are conflicting regarding the relationship between ulnar styloid fracture (USF) location and distal radioulnar joint (DRUJ) instability in patients with distal radius fracture (DRF) and concomitant USF. The objective of this study was to determine the association of USF location with TFCC foveal tear and factors associated with DRUJ instability in patients with both DRF and USF. MATERIALS AND METHODS Fifty-four patients with both DRF and USF who had wrist MRI examination before surgery were analyzed. USF location (tip or base) and TFCC foveal insertion status (intact, partial tear, or complete tear or avulsion with fractured fragment) were evaluated. DRUJ stability was assessed intra-operatively after fixation of the radius. Factors potentially associated with DRUJ instability, such as age, gender, USF location, USF fragment gap, radioulnar distance, radial shortening, and TFCC foveal tear, were analyzed. RESULTS Among 54 patients, 37 (69%) and 17 (31%) had USF at the base and the tip, respectively. In patients with base fractures, TFCC foveal insertion was found to be disrupted in 89% (33/37) patients (complete tear in 11 and partial tear in 22) but intact in 11% (4/37). On the contrary, in patients with tip fractures, the insertion was found to be disrupted in 88% (15/17) patients (complete tear in 2 and partial tear in 13) but intact in 12% (2/17). After fixation of the radius, total 52% (28/54) patients showed DRUJ instability. Especially, DRUJ instability was found in 57% (21/37) of ulna styloid process base fracture patients and 41% (7/17) of ulna styloid process tip fracture patients. In univariate analysis, complete tear of TFCC foveal insertion and wider USF fragment distance were associated with DRUJ instability. CONCLUSIONS Tears of TFCC foveal insertion are common in patients with DRF and concomitant ulnar styloid base fractures. Based on the findings of this study, tear of TFCC foveal insertion seems to be also common in patients with DRF and concomitant ulnar styloid tip fractures. And also, DRUJ instability seems to be associated with a TFCC foveal tear independent of USF location.
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Affiliation(s)
- Kyung Wook Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Che Ho Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Heouk Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea. .,Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.
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Yoon H, Kang Y, Kim HJ, Lee E, Ahn JM, Lee JW. Dual-layer spectral detector CT arthrography of the shoulder: assessment of image quality and value in differentiating calcium from iodine. Acta Radiol 2023; 64:638-647. [PMID: 35300534 DOI: 10.1177/02841851221087991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dual-layer spectral detector computed tomography (DLCT) may potentially improve CT arthrography through enhanced image quality and analysis of the chemical composition of tissue. PURPOSE To evaluate the image quality of monoenergetic reconstructions from DLCT arthrography of the shoulder and assess the additional diagnostic value in differentiating calcium from iodine. MATERIAL AND METHODS Images from consecutive shoulder DLCT arthrography examinations performed between December 2016 and February 2018 were retrospectively reviewed for hyperattenuating lesions within the labrum and tendons. The mean attenuation of the target lesion, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the virtual monoenergetic images obtained at 40-200 keV were compared with conventional 140-kVp images. Two evaluators independently classified each target lesion as contrast media or calcification, without and with DLCT spectral data. Receiver operating curve (ROC) analysis was performed to assess the diagnostic performance of shoulder DLCT arthrography, without and with the aid of spectral data. RESULTS The study included 20 target lesions (18 DLCT arthrography examinations of 17 patients). The SNRs of the monoenergetic images at 40-60 keV were significantly higher than those of conventional images (P < 0.05). The CNRs of the monoenergetic images at 40-70 keV were significantly higher than those of conventional images (P < 0.001). The ability to differentiate calcium from iodine, without and with DLCT spectral data, did not significantly differ (P = 0.441 and P = 0.257 for reviewers 1 and 2, respectively). CONCLUSION DLCT had no additive value in differentiating calcium from iodine in small, hyperattenuating lesions in the labrum and tendons.
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Affiliation(s)
- Hyeyoung Yoon
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 65633Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eugene Lee
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Um MK, Lee E, Lee JW, Kang Y, Ahn JM, Kang HS. Fluoroscopic lumbar transforaminal epidural steroid injections for recurrent herniated intervertebral disc after discectomy: Effectiveness and outcome predictors. PLoS One 2022; 17:e0271054. [PMID: 35797391 PMCID: PMC9262237 DOI: 10.1371/journal.pone.0271054] [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: 10/21/2021] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite transforaminal epidural steroid injection (ESI) being the first choice in patient with recurrent herniated intervertebral disc (HIVD), efficacy of ESI in those patients are not well established. Herein, we evaluate the effectiveness and outcome predictors of fluoroscopic transforaminal ESI for recurrent HIVD. Methods Seventy-seven patients (48 male; mean age, 51.3 years) with recurrent lumbar HIVD were included and divided into three groups according to initial treatment: conservative treatment, transforaminal ESI, and immediate surgery. ESI effectiveness was evaluated by operation rates, injection numbers in 6 months, and pain reduction (visual analog scale (VAS) scores). Clinical and MRI variables were analyzed as possible outcome predictors. Each subject in the transforaminal ESI group was individually matched to two patients with initial HIVD (control group). Results In the transforaminal ESI group (n = 37), 20 patients (54.1%) did not undergo reoperation. The initial and follow-up VAS scores were significantly higher in the reoperation group (p = 0.014, p = 0.019, respectively). Patients with either paresthesia or motor weakness (12/19, 63.2%) had a significantly higher reoperation rate than patients with only pain (5/18, 27.8%; p = 0.031). Extruded disc ratios ≥2.0 were significantly higher in the reoperation group (10/17, 58.8%; p = 0.048). The reoperation rate in the transforaminal ESI group (17/37, 45.9%) was higher than the operation rate in the control group (6/73, 8.2%; p<0.001). Conclusion Transforaminal ESI was effective in reducing radicular pain in patients with recurrent HIVD. Approximately 54% of patients did not undergo reoperation. An extruded disc ratio ≥2.0 and paresthesia or motor weakness were poor outcome predictors.
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Affiliation(s)
- Mi-Kyung Um
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- Department of Radiology, Kangwon National University School of Medicine, Chuncheon-si, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- * E-mail:
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Yoon SJ, Ahn JM, Kang Y, Kim BR, Kang HS. Morphological changes in the superficial medial collateral ligament on knee MR imaging: association with medial meniscal extrusion and posterior root medial meniscus abnormality. Skeletal Radiol 2022; 51:1399-1405. [PMID: 34913988 DOI: 10.1007/s00256-021-03978-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the association between morphological changes in the superficial medial collateral ligament and meniscal extrusion with medial meniscus posterior root tear. MATERIALS AND METHODS From January 1, 2018, to December 31, 2019, 124 patients who underwent knee MRI within 90 days prior to knee surgery and whose medial meniscus surgically proved intact, with posterior root tear or posterior horn tear, were enrolled. Two radiologists who were blinded to the surgical results assessed the morphological changes in the superficial medial collateral ligament, including thickness, bowing angle, and presence of signal intensity alteration, and medial meniscus extrusion, according to the presence of tears in the posterior root of the medial meniscus or posterior horn of the medial meniscus using the chi-square test, one-way ANOVA, and Cohen's kappa test. RESULTS Thirty-six posterior root tears, 31 posterior horn tears, and 57 intact medial menisci were observed surgically. The mean values of thickness showed no significant differences among the three groups. The bowing angle was significantly higher in the posterior root tear than in the posterior horn tear (reader 1 = 0.001, reader 2 = 0.002) and normal meniscus groups (readers 1 and 2 < 0.001). The percentage of superficial medial collateral ligament signal intensity alteration and meniscal extrusion was highest in the group with posterior root of the medial meniscus tear (80.6% and 94.4%, respectively) and lowest in the group with normal medial meniscus (17.5% and 10.5%, respectively). CONCLUSION Morphological changes in the superficial medial collateral ligament and meniscal extrusion were associated with medial meniscus posterior root tears.
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Affiliation(s)
- So Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, South Korea
- Department of Radiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, South Korea.
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, South Korea
| | - Bo Ram Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, South Korea
| | - Heung-Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, South Korea
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Chang H, Kang Y, Ahn JM, Lee E, Lee JW, Kang HS. Texture analysis of magnetic resonance image to differentiate benign from malignant myxoid soft tissue tumors: A retrospective comparative study. PLoS One 2022; 17:e0267569. [PMID: 35587928 PMCID: PMC9119440 DOI: 10.1371/journal.pone.0267569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
It is important to differentiate between benign and malignant myxoid tumors to establish the treatment plan, determine the optimal surgical extent, and plan postoperative surveillance, but differentiation may be complicated by imaging-feature overlap. Texture analysis is used for quantitative assessment of imaging characteristics based on mathematically calculated pixel heterogeneity and has been applied to the discrimination of benign from malignant soft tissue tumors (STTs). In this study, we aimed to assess the diagnostic value of the texture features of conventional magnetic resonance images for the differentiation of benign from malignant myxoid STTs. Magnetic resonance images of 39 patients with histologically confirmed myxoid STTs of the extremities were analyzed. Qualitative features were assessed and compared between the benign and malignant groups. Texture analysis was performed, and texture features were selected based on univariate analysis and Fisher’s coefficient. The diagnostic value of the texture features was assessed using receiver operating curve analysis. T1 heterogeneity showed a statistically significant difference between benign and malignant myxoid STTs, with substantial inter-reader reliability. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1 heterogeneity were 55.6%, 83.3%, 88.2%, 45.5%, and 64.1%, respectively. Among the texture features, T2w-WavEnLL_s-3 showed good diagnostic performance, and T2w-WavEnLL_s-4 and GeoW4 showed fair diagnostic performance. The logistic regression model including T1 heterogeneity and T2_WavEnLL_s-4 showed good diagnostic performance. However, there was no statistically significant difference between the overall qualitative assessment by a radiologist and the predictor model. Geometry-based and wavelet-derived texture features from T2-weighted images were significantly different between benign and malignant myxoid STTs. However, the texture features had a limited additive value in differentiating benign from malignant myxoid STTs.
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Affiliation(s)
- Hyunsik Chang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
- * E-mail:
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
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Ram Kim B, Kang Y, Lee J, Choi D, Joon Lee K, Mo Ahn J, Lee E, Woo Lee J, Sik Kang H. Tumor grading of soft tissue sarcomas: assessment with whole-tumor histogram analysis of apparent diffusion coefficient. Eur J Radiol 2022; 151:110319. [DOI: 10.1016/j.ejrad.2022.110319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
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Kim BR, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Effectiveness of epidural steroid injection in patients with lumbar herniated intervertebral disc under a "wait-and-see" policy. Acta Radiol 2022; 63:67-75. [PMID: 33435714 DOI: 10.1177/0284185120985500] [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: 12/13/2022]
Abstract
BACKGROUND There are no consensus and guidelines on the optimal interval of repeat epidural steroid injections (ESI) for patients with lumbar herniated intervertebral disc (HIVD) who respond to initial ESI. PURPOSE To evaluate the effectiveness of ESI in patients with HIVD under a "wait-and-see" policy, i.e. as-needed injections not on a predetermined schedule. MATERIAL AND METHODS A total of 592 patients with lumbar HIVD received spine injections between January and December 2017. After excluding patients with excellent (no pain) or poor (>70% residual symptoms) response in the two- or three-week pain assessment, the data of 141 responders were analyzed (60 men, 73 women; age = 50.55±17.25 years). We divided patients into wait-and-see (n=124) and early repeat-ESI (n=17) groups, who received repeat ESIs within three weeks. Evaluations of characteristics and outcomes were performed with the chi-square test or independent Student's t-test. RESULTS Six patients (4.8%) in the wait-and-see group and 1 (5.9%) in the early repeat-ESI group underwent operation within one year (P=0.85). A mean of 1.52±0.82 ESIs was performed in the wait-and-see and a mean of 2.29±0.47 ESIs in the early repeat-ESI group over one year (P<0.001). The time interval between the first and second ESIs was longer in the wait-and-see group than in the early repeat-ESI group (97.15 vs. 15.47 days, P<0.001). Seventy-eight patients (62.9%) in the wait-and-see group could control their pain with a single ESI. CONCLUSION A "wait-and-see" policy could be an effective pain management option for patients with lumbar HIVD who respond to initial ESI.
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Affiliation(s)
- Bo Ram Kim
- 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
| | - Eugene Lee
- 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
| | - 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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Kim BR, Lee J, Ahn JM, Kang Y, Lee E, Lee JW, Kang HS. Predicting the clinically significant subscapularis tendon tear: malposition and tear of the long head of the biceps tendon on shoulder magnetic resonance imaging. Acta Radiol 2021; 62:1648-1656. [PMID: 33325726 DOI: 10.1177/0284185120980017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The diagnostic accuracy of magnetic resonance imaging (MRI) is low for detecting a subscapularis tendon tear. PURPOSE To identify MRI findings that may predict the presence of a clinically significant subscapularis tendon tear requiring surgical repair. MATERIAL AND METHODS We reviewed shoulder MR images of patients who had undergone arthroscopic rotator cuff repair at our institution between June 2018 and May 2019. Patients were divided into two groups: the study group (n = 51), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI and intermediate or higher grade of the tendon tear proven on arthroscopy; and the control group (n = 18), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI but no tear or low-grade partial thickness tear of the tendon shown on arthroscopy. Preoperative MR images were retrospectively evaluated by two readers for the size of the subscapularis tendon tear, bone reactions at the lesser tuberosity, and long head of the biceps tendon (LHBT) pathology. RESULTS The subscapularis tendon tear measured by reader 2 was larger in the study group than in the control group. The prevalence of a tear (P = 0.006 for reader 1; P = 0.011 for reader 2) and malposition (P < 0.001 for both readers) of the LHBT were significantly greater in the study group. CONCLUSION A tear and malposition of the LHBT on MR images may predict the presence of a clinically significant subscapularis tendon tear.
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Affiliation(s)
- Bo Ra Kim
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jaehyung Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Kim JS, Shah GM, Chae YJ, Hwang JS, Ahn JM, Gong HS. Ulnar nerve morphology on magnetic resonance imaging predicts nerve recovery after surgery for cubital tunnel syndrome. Hand Surg Rehabil 2021; 41:90-95. [PMID: 34763114 DOI: 10.1016/j.hansur.2021.10.316] [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] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.
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Affiliation(s)
- J S Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - G M Shah
- Department of Orthopedics and Trauma Surgery, Patan Academy of Health Sciences, Lagankhel-5, 44700 Bagmati, Nepal
| | - Y J Chae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - J M Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Jeong HJ, Ahn JM, Oh JH. Trabecular Bone Score Could Not Predict the Bone Mineral Density of Proximal Humerus. J Bone Metab 2021; 28:239-247. [PMID: 34520658 PMCID: PMC8441531 DOI: 10.11005/jbm.2021.28.3.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022] Open
Abstract
Background Osteoporosis is an important clinical factor for tendon healing after arthroscopic rotator cuff repair (ARCR). Conventional dual energy X-ray absorptiometry (DXA) of the hip and lumbar spine (LS) does not represent proximal humeral bone mineral density (BMD). Theoretically, direct measurement of the BMD of the proximal humerus is the best method; however, it is not popular and is non-standardized. Therefore, we evaluate whether the trabecular bone score (TBS) using LS DXA would represent proximal humeral BMD. Methods Conventional hip and LS DXA and proximal humeral BMD were measured in 212 consecutive ARCR patients, and TBS was calculated using LS DXA. Comparative analysis between the affected and contralateral asymptomatic shoulders was done; moreover, correlation analysis was conducted to evaluate the representativity of TBS for proximal humeral BMD. Regression analysis was performed to elucidate the risk factor of intraoperative suture anchor failure (ISAF). Results BMDs of the affected shoulder were significantly lower than those of the contralateral side (all P<0.05). TBS failed to present a strong correlation with proximal humeral BMD (correlation coefficients 0.155–0.506, all P<0.05), and the BMD of the greater tuberosity (GT) of the proximal humerus was revealed to be a sole risk factor for ISAF (odds ratio, 0.01, P=0.020). Conclusions TBS and conventional hip and LS DXA did not represent proximal humeral BMD. Furthermore, among the various radiological measurements, the BMD of the GT was a sole risk factor of ISAF. Therefore, further research for the direct measurement of proximal humeral BMD is mandatory to predict proximal humeral focal osteoporosis.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Bae KJ, Park C, Ahn JM, Kang Y, Gong HS. Magnetic resonance imaging evaluation of patients with clinically diagnosed medial Epicondylitis. Skeletal Radiol 2021; 50:1629-1636. [PMID: 33483771 DOI: 10.1007/s00256-021-03720-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated magnetic resonance imaging (MRI) findings in patients with clinically diagnosed medial epicondylitis (ME) and determined whether any of the MRI findings correlated with the follow-up pain level after nonoperative treatment. MATERIALS AND METHODS We retrospectively reviewed 83 patients who had undergone elbow MRI examinations for clinically diagnosed ME and who were followed-up for more than 6 months. Five categories of MRI findings were selected for qualitative grading: common flexor tendon (CFT) origin signal changes, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, bony changes of the medial epicondyle, and calcification. The mean follow-up after MRI examination was 21 months. We performed multivariate regression analysis to analyze whether any of these MRI findings were associated with the follow-up pain level after nonoperative treatment. RESULTS Positive MRI findings included CFT origin signal changes (66%), ulnar neuritis (40%), UCL insufficiency (30%), calcification (27%), and bony changes (18%). Multivariate analysis indicated that CFT origin signal changes were independently associated with the follow-up pain level (β = 3.387; p = 0.004). CONCLUSION In patients with clinically diagnosed ME, MRI demonstrated diverse abnormal findings in the CFT origin, ulnar collateral ligament, ulnar nerve, and bone. Among the findings, the severity CFT origin signal changes, which indicates the severity of tendon degeneration in ME, was associated with the follow-up pain level. This information can be helpful in consulting on the prognosis of nonoperative treatment in patients with clinically diagnosed ME.
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Affiliation(s)
- Kee Jeong Bae
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chulhee Park
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Gyeonggi-do, Seongnam-si, 463-707, South Korea.
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Kim YS, Kim ST, Lee KH, Ahn JM, Gong HS. Radiocapitellar incongruity of the radial head in magnetic resonance imaging correlates with pathologic changes of the lateral elbow stabilizers in lateral epicondylitis. PLoS One 2021; 16:e0254037. [PMID: 34234369 PMCID: PMC8263266 DOI: 10.1371/journal.pone.0254037] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Post-traumatic posterolateral rotatory instability (PLRI) can be shown as radiocapitellar incongruity or posterior translation (PT) of the radial head in magnetic resonance imaging (MRI). We aimed to evaluate whether PT correlated with pathologic changes of lateral elbow stabilizers in patients with lateral epicondylitis. MATERIALS AND METHODS In MRIs of 160 patients with lateral epicondylitis, we measured PT of the radial head in the sagittal images. We qualitatively graded five lesions of the lateral elbow structures that included common extensor tendon (CET) lesion (grade 1-3), lateral collateral ligament complex (LCLC) insufficiency (grade 0-2), and absence or presence of bone marrow signal change, osteochondral lesion, and calcification. We analyzed whether the PT correlated with pathologic changes of the lateral elbow stabilizers and evaluated the diagnostic value of the PT for severe lesions. RESULTS The average PT was 1.9 mm. The PT correlated with both the CET lesion (p < 0.001) and LCLC insufficiency (p < 0.001). The optimal cutoff values of the PT for grade 3 CET lesion and grade 2 LCLC lesion were 2.6 and 2.8 mm, respectively. When potential PLRI was defined as the PT of > 3.4mm as suggested for post-traumatic PLRI, 21 patients had potential PLRI. The positive predictive values of the PT > 3.4mm were 76% for grade 3 CET lesions and 67% for grade 2 LCLC insufficiency. CONCLUSION This study demonstrates that PT of the radial head correlates with pathological changes of the lateral elbow stabilizers. As radiocapitellar incongruity is easy to measure quantitatively, it can be used for screening potential PLRI in patients with lateral epicondylitis.
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Affiliation(s)
- Yeun Soo Kim
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Sung Taeck Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Hwan Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- * E-mail:
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Yeo JB, Lee E, Lee JW, Kim BR, Kang Y, Ahn JM, Park SM, Kang HS. Immediate postoperative MRI findings after lumbar decompression surgery: Correlation of imaging features with clinical outcome. J Clin Neurosci 2021; 89:365-374. [PMID: 34088576 DOI: 10.1016/j.jocn.2021.05.045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/25/2020] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. We retrospectively analyzed the immediate postoperative MRIs of 121 consecutive patients who underwent lumbar decompression surgery between July 2017 and June 2018. Changes in stenosis at the decompressed and adjacent levels, epidural fat edema, epidural and subdural fluid collections, nerve root swelling, facet joint effusions, intervertebral disc signal, and paravertebral muscle edema were correlated with clinical characteristics. Both groups had reduced central canal stenosis postoperatively (p < 0.001) but worsened stenosis at adjacent segments. Fluid collection, hemorrhagic or non-hemorrhagic, at the laminectomy site was the commonest finding (one-level: 73.8%, two-level: 88.5%), with a higher percentage of severe central canal compromise in the two-level decompression group (p = 0.003). Other postoperative MRI findings, such as epidural fat edema, nerve root swelling, subdural fluid collection, and facet joint effusion, were noted without statistical significance. In conclusion, even with successful decompression for lumbar canal stenosis, increased central canal stenosis at adjacent segments is common on immediate postoperative MRI scans, showing no statistically significant correlation with the immediate postoperative outcome. Postoperative fluid collection at the laminectomy site is the commonest imaging finding, and higher rates of hemorrhagic fluid and more severe central canal compromise occur in two-level decompression, but rarely cause clinical problems.
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Affiliation(s)
- Joon Bum Yeo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Bo Ram Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Um MK, Lee E, Lee JW, Lee KS, Kang Y, Ahn JM, Kang HS. Sporadic Intradural Extramedullary Hemangioblastoma Not Associated with von Hippel-Lindau Syndrome: A Case Report and Literature Review. Taehan Yongsang Uihakhoe Chi 2021; 82:700-707. [PMID: 36238793 PMCID: PMC9432444 DOI: 10.3348/jksr.2020.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 06/16/2023]
Abstract
Hemangioblastomas are low-grade, highly vascular tumors that are usually associated with von Hippel-Lindau syndrome. Hemangioblastomas most commonly occur in the cerebellum, and intradural extramedullary hemangioblastoma of the cauda equina is very rare, especially in patients without von Hippel-Lindau syndrome. Herein, we report a case of intradural extramedullary hemangioblastoma of the cauda equina that was not associated with von Hippel-Lindau syndrome, with a focus on its imaging characteristics and differential diagnoses. We compared the clinical presentation and imaging features of our case with those of previously reported cases in the review of the literature.
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Yoon H, Kang Y, Park H, Ahn JM, Lee E, Lee JW, Kang HS. Sonographic Appearance of Steatocystoma: An Analysis of 14 Pathologically Confirmed Lesions. Taehan Yongsang Uihakhoe Chi 2021; 82:382-392. [PMID: 36238747 PMCID: PMC9431942 DOI: 10.3348/jksr.2019.0200] [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: 12/21/2019] [Revised: 03/20/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Purpose To evaluate the ultrasonographic characteristics of steatocystomas focusing on the features that aid in differentiating them from epidermal inclusion cysts and lipomas. Materials and Methods The ultrasonographic findings of 14 histologically proven steatocystomas in 10 patients were retrospectively reviewed. The following features were assessed: the layer of involvement, shape, margin, echogenicity, posterior acoustic features, and the presence of a visible wall or intralesional striations. The findings were compared with those of subcutaneous lipomas and epidermal inclusion cysts to identify those findings that aid in the differential diagnosis of steatocystomas. Results The majority of steatocystomas appeared as a subcutaneous mass (n = 6, 42.9%) or a mass involving both the dermal and subcutaneous layers (n = 6, 42.9%). Steatocystomas exhibited a well-defined smooth margin (n = 12, 85.7%) and homogeneous echogenicity (n = 9, 64.3%), and showed no specific posterior acoustic features (n = 9, 64.3%). The most important features that differentiated steatocystomas from epidermal inclusion cysts were a homogeneous internal echotexture (p = 0.009) and absent or less prominent posterior acoustic enhancement (p < 0.001). The features that distinguished steatocystomas from lipomas were the margin (p < 0.001), echogenicity (p = 0.034), internal echotexture (p = 0.004), and the absence of intralesional striations (p < 0.001). Conclusion Steatocystomas appeared as well-defined homogeneous masses with mild or absent posterior acoustic enhancement.
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Jang HY, Choi GH, Hwang SH, Jang ES, Kim JW, Ahn JM, Choi Y, Cho JY, Han HS, Lee J, Chung JW, Baeg JY, Jeong SH. Sarcopenia and visceral adiposity predict poor overall survival in hepatocellular carcinoma patients after curative hepatic resection. Transl Cancer Res 2021; 10:854-866. [PMID: 35116415 PMCID: PMC8799077 DOI: 10.21037/tcr-20-2974] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/02/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022]
Abstract
Background This study investigated the association of 3 components of body composition (sarcopenia, intramuscular fat deposition and visceral adiposity) with the overall or recurrence-free survival of hepatocellular carcinoma (HCC) patients who underwent curative hepatic resection. Methods One hundred sixty newly diagnosed and surgically treated HCC patients were retrospectively enrolled from 2003 to 2011. Three items of body composition were measured using the 3rd lumbar level image of preoperative computed tomography (CT): psoas muscle index (PMI), psoas muscle attenuation (PMA), and visceral adipose tissue index (VATI). Sex-specific optimal cut-off for each item was determined from receiver-operating characteristic curves. Results The HCC patients showed a median age of 55 years, 75% of male, 78% of hepatitis B surface antigen positivity, and 96% of Child-Pugh A. The sarcopenic group (PMI less than the sex-specific cutoff of 3.33 cm2/m2 for men and 2.38 cm2/m2 for women) had 17.5% of the patients with a lower PMA (more fat deposition) but similar VATI compared to the non-sarcopenic group. PMI showed a positive correlation with PMA (ρ=0.493, P<0.001), while there was no significant correlation between PMI and VATI, and between PMA and VATI. On the multivariate analysis, a high PMI and low VATI were independent factors affecting overall survival while PMA was not. Nevertheless, PMI and VATI were not independent factors for recurrence-free survival. Conclusions In curatively resected HCC patients, sarcopenia and high visceral adiposity predict poor overall survival but not recurrence-free survival, while PMA did not predict overall survival.
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Affiliation(s)
- Hee Yoon Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Gwang Hyeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sung Ho Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Youngrok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jaebong Lee
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung Wha Chung
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo-si, Gyeonggi-do, Republic of Korea
| | - Joo Yeong Baeg
- Department of Internal Medicine, Sheikh khalifa Speciality Hospital, Ras al Khaimah, United Arab Emirates
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Kim HJ, Lee E, Lee JW, Kang Y, Ahn JM. Efficacy of Fluoroscopy-Guided Lumbar Facet Joint Synovial Cyst Rupture with Intra-Articular Steroid Injection after Laminectomy. Taehan Yongsang Uihakhoe Chi 2021; 82:162-172. [PMID: 36237472 PMCID: PMC9432400 DOI: 10.3348/jksr.2019.0184] [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: 11/14/2019] [Revised: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 06/16/2023]
Abstract
PURPOSE We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet. MATERIALS AND METHODS We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up. RESULTS The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients. CONCLUSION For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.
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Lee E, Lee JW, Bae YJ, Kim HJ, Kang Y, Ahn JM. Reliability of pre-operative diffusion tensor imaging parameter measurements of the cervical spine in patients with cervical spondylotic myelopathy. Sci Rep 2020; 10:17410. [PMID: 33060848 PMCID: PMC7566607 DOI: 10.1038/s41598-020-74624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
The present study assessed test–retest and inter-observer reliability of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy (CSM), as well as the agreement among measurement methods. A total 34 patients (12 men, 22 women; mean age, 58.7 [range 45–79] years) who underwent surgical decompression for CSM, with pre-operative DTI scans available, were retrospectively enrolled. Four observers independently measured fractional anisotropy (FA) values twice, using three different measurement methods. Test–retest and inter-observer reliability was assessed using intraclass correlation coefficients (ICCs). Overall, inter-observer agreements varied according to spinal cord level and the measurement methods used, and ranged from poor to excellent agreement (ICC = 0.374–0.821), with relatively less agreement for the sagittal region of interest (ROI) method. The radiology resident and neuro-radiologist group showed excellent test–retest reliability at almost every spinal cord level (ICC = 0.887–0.997), but inter-observer agreements varied from fair to good (ICC = 0.404–0.747). Despite excellent test–retest reliability of the ROI measurements, FA measurements in patients with CSM varied widely in terms of inter-observer reliability. Therefore, DTI parameter data should be interpreted carefully when applied clinically.
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Affiliation(s)
- Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
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Kim HJ, Ahn JM, Kim Y, Kang Y, Lee E, Lee JW, Kang HS. Association of meniscal flounce in the knee with the pattern and location of meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles: a magnetic resonance evaluation. Skeletal Radiol 2020; 49:1277-1284. [PMID: 32206830 DOI: 10.1007/s00256-020-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association of meniscal flounce with the pattern and location of the meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles. MATERIALS AND METHODS A total of 283 knees of 280 patients were retrospectively reviewed over a 9-month period. Thirty-one magnetic resonance images of patients with meniscal flounce were compared with those of age- and sex-matched control group (n = 62) without meniscal flounce. The presence of meniscal tear was evaluated and, if present, its location and pattern were recorded. The amount of joint effusion was graded, and the joint angle was measured. The Fisher's exact, Cochran-Armitage trend, and t tests were performed to compare the findings between the two groups. The decision tree analysis was employed to determine the most significant factor of meniscal flounce. RESULTS Meniscal flounce was present in 11.0% (31/283) of the adult population. Approximately 80.6% of meniscal flounce occurred in the torn medial menisci. The presence of meniscal flounce was significantly associated with tears at the body (p = 0.007), posterior horn (p = 0.001), and meniscocapsular junction (p = 0.002) of the medial meniscus. The decision tree analysis revealed that the posterior horn tear of the medial meniscus was the most significant predictor of meniscal flounce. CONCLUSION The most significant factor associated with meniscal flounce is tear at the posterior horn of the medial meniscus, followed by tear at the meniscocapsular junction.
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Affiliation(s)
- Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Youngjune Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Heung-Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Choi K, Jang HY, Ahn JM, Hwang SH, Chung JW, Choi YS, Kim JW, Jang ES, Choi GH, Jeong SH. The association of the serum levels of myostatin, follistatin, and interleukin-6 with sarcopenia, and their impacts on survival in patients with hepatocellular carcinoma. Clin Mol Hepatol 2020; 26:492-505. [PMID: 32646201 PMCID: PMC7641544 DOI: 10.3350/cmh.2020.0005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Aims The role of serum myokine levels in sarcopenia and the outcome of hepatocellular carcinoma (HCC) patients are not clear. This study investigated the serum levels of myostatin, follistatin, and interleukin-6 (IL-6) in HCC patients and their association with sarcopenia and survival. Methods Using prospectively collected pretreatment samples from 238 HCC patients in a hospital from 2012 to 2015, the serum levels of 3 myokines were determined and compared to 50 samples from age and sex-matched healthy controls. Sarcopenia was evaluated using the psoas muscle index (PMI) measured at the third lumbar level in the computed tomography, and clinical data were collected until 2017. Results The median levels of the 3 myokines for the male and female HCC patients were as follow: myostatin (3,979.3 and 2,976.3 pg/mL), follistatin (2,118.5 and 2,174.6 pg/mL), and IL-6 (2.5 and 2.7 pg/mL), respectively. Those in the HCC patients were all significantly higher than in the healthy controls. In the HCC patient, the median PMI was 4.43 (males) and 2.17 cm2/m2 (females) with a sarcopenic prevalence of 56.4%. The serum levels of myostatin, IL-6 and follistatin in the HCC patients showed a positive, negative, and no correlation with PMI, respectively. The serum follistatin level was an independent factor for poor survival in HCC patients. Conclusions The serum levels of myostatin, follistatin, and IL-6 and their correlation with sarcopenia and survival were presented in HCC patients for the first time. The role of the serum follistatin level as a poor prognostic biomarker warrants further study.
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Affiliation(s)
- Kanghyug Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Yoon Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Ho Hwang
- Department of Nursing, Daewon Univeristy College, Jecheon, Korea
| | - Jung Wha Chung
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Sanbon, Korea
| | - Yun Suk Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gwang Hyeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Lee J, Lee E, Lee JW, Kang Y, Ahn JM, Kang HS. Percutaneous Sacroplasty : Effectiveness and Long-Term Outcome Predictors. J Korean Neurosurg Soc 2020; 63:747-756. [PMID: 32455518 PMCID: PMC7671780 DOI: 10.3340/jkns.2020.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). METHODS This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients' magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. RESULTS Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). CONCLUSION PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.
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Affiliation(s)
- Jaehyung Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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24
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Ko YJ, Lee E, Lee JW, Park CY, Cho J, Kang Y, Ahn JM. Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems. PLoS One 2020; 15:e0233633. [PMID: 32459814 PMCID: PMC7252624 DOI: 10.1371/journal.pone.0233633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/13/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.
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Affiliation(s)
- Yeon-jee Ko
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Joon Woo Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chi Young Park
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungheum Cho
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Yoo BR, Lee E, Lee JW, Kang Y, Ahn JM, Kang HS. Incidence and pattern of epidural spread during lumbar facet joint injection: a prospective study. Acta Radiol 2020; 61:636-643. [PMID: 31510763 DOI: 10.1177/0284185119874480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In clinical practice, we have often observed contrast material spreading into the epidural space during lumbar facet joint injection. However, the exact incidence of epidural spread and contrast pattern have not been reported. Purpose To evaluate the incidence and pattern of epidural spread in lumbar facet joint injection. Material and Methods One hundred consecutive patients (38 men, 62 women; mean age 68 years; age range 20–88 years) who underwent lumbar facet joint injection at two sites between April 2014 and June 2014 were investigated in this prospective study. Initial oblique, final anteroposterior, and lateral fluoroscopic images were obtained and evaluated for the presence of epidural spread and its contrast pattern (based on direction and extent) with the consensus of three radiologists. The relationship between epidural spread and its potential predictors was analyzed using the chi-squared test, Fisher’s exact test, and the t-test. Results The incidence of epidural spread during lumbar facet joint injection was 64.6% (n=64) in 99 patients and 49.5% (n=95) in 192 procedures; ventral spread occurred in 29.2% and foraminal spread in 18.8%. When epidural spread occurred, the most commonly identified distributions were unilateral (73.7%), dorsal (92.6%), and cephalad (92.6%). Epidural spread increased significantly in the caudocephalic direction ( P < 0.0001), in men (relative risk [RR]=1.478), in the adjacency of posterior fusion level (RR=1.545), in patients with spondylolisthesis (RR=1.454), and when there was no other leakage (RR=0.334). Conclusion Epidural spread occurred at about half the number of lumbar facet joint injections and showed a contrast pattern similar to that seen with the interlaminar approach.
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Affiliation(s)
- Bo Reum Yoo
- Department of Radiology, Cosmo Internal Medicine, Daejeon, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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26
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Shim E, Lee E, Lee JW, Kang Y, Ahn JM, Kang HS. Feasibility of postoperative 3-tesla diffusion tensor imaging in cervical spondylotic myelopathy: A comparison of single-shot EPI and multi-shot EPI. Eur J Radiol 2020; 122:108751. [DOI: 10.1016/j.ejrad.2019.108751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/22/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
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Um MK, Lee E, Lee JW, Lee KS, Kang Y, Ahn JM, Kang HS. Spinal Intraosseous Hibernoma: A Case Report and Review of Literature. J Korean Soc Radiol 2020; 81:965-971. [PMID: 36238169 PMCID: PMC9432202 DOI: 10.3348/jksr.2020.81.4.965] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/28/2023]
Abstract
Hibernoma is a rare benign tumor that arises from vestiges of brown fat. Spinal intraosseous hibernoma has only recently been described in the literature, and only 12 cases have been reported to date due to its extreme rarity. Here, we report the case of a patient who was incidentally diagnosed with an intraosseous hibernoma in the thoracic spine, following a diverse imaging work-up and pathologic confirmation. We correlate the clinical presentation and imaging features of our case with those of previously reported cases during our review of the literature.
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Affiliation(s)
- Mi-Kyung Um
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Park SY, Park KS, Lee E, Lee JW, Bae YJ, Kang Y, Ahn JM, Kang HS. Various MRI Findings of Toxocara canis Myelitis. J Korean Soc Radiol 2020; 81:135-146. [PMID: 36238126 PMCID: PMC9432088 DOI: 10.3348/jksr.2020.81.1.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022]
Abstract
목적 개회충 척수염의 자기공명영상 10예를 보고하고, 개회충 척수염 진단에 도움이 되는 다양한 영상 소견을 분석하고자 한다. 대상과 방법 2015년 6월부터 2018년 3월까지 본원에서 개회충 척수염으로 진단받은 환자들을 대상으로 의무기록과 촬영한 척추 자기공명영상 소견을 척추영상 전문의 1명과 영상의학과 전공의 1명이 후향적으로 분석하였다. 결과 본 연구는 개회충 척수염의 자기공명영상 소견을 다음 두 가지로 분류하였다. 먼저 type 1은 축상면에서 중심부, 미만성 T2 고신호강도가 보이는 경우로 50%가 해당되며 모든 환자에서 병변의 뚜렷한 조영증강이 있었으며 대부분의 경우(4예, 80%)에서 후외측 또는 후방의 결절성 조영증강을 보였다. Type 2는 후외측 혹은 후방에서 쐐기 모양 또는 국소적 T2 고신호강도의 병변이 보이는 경우로 분류하였으며, 50%에 해당한다. 이 경우 병변의 범위가 상대적으로 작았고 조영증강은 1예에서만 관찰되었다. 결론 개회충 척수염의 자기공명영상이 다양한 소견으로 나타날 수 있음을 확인하였고 이를 통해 개회충 척수염의 자기공명영상 소견을 2가지로 분류하여 제시하였다.
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Affiliation(s)
- Sun Young Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, 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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Kang WY, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone. Korean J Pain 2019; 32:178-186. [PMID: 31257826 PMCID: PMC6615449 DOI: 10.3344/kjp.2019.32.3.178] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 01/31/2023] Open
Abstract
Background Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. Methods This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. Results Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). Conclusions Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.
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Affiliation(s)
- Woo Young Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
BACKGROUND The ligamentum teres has been recognized as an important stabilizer of the hip. PURPOSE We aimed to examine the relationship between non-traumatic ligamentum teres (LT) tear and hip morphometry on magnetic resonance imaging (MRI). MATERIAL AND METHODS Fifty patients who had undergone hip MRI were included (27 men, 23 women; average age = 54.0 years). The status of the LT and the morphometric hip parameters were assessed, including acetabular anteversion angle (AAA), acetabular depth (AD), acetabular index (AI), lateral center edge angle (LCEA), and extrusion index (EI). The morphometric hip parameters were compared between groups with one-way ANOVA, Student's t-test, and Mann-Whitney U test. RESULTS A decreased acetabular coverage was noted in the severe tear group compared to the normal group, indicated by a significantly larger AD ( P = 0.001) and smaller LCEA ( P = 0.016). There was a statistically significant difference in the AAA, AD, and LCEA between the normal group and the complete tear group; the AAA was significantly larger ( P = 0.031), the AD was significantly larger ( P = 0.01), and the LCEA was significantly smaller ( P = 0.043) in the complete tear group compared to the normal group. CONCLUSION There is an association between LT tears and acetabular bony morphology; an insufficient acetabular coverage is associated with complete tear of the LT. As the insufficient acetabular coverage may predispose to ligamentum teres tear, the ligamentum teres should be thoroughly evaluated in those with insufficient acetabular coverage, as a potential cause of hip pain.
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Affiliation(s)
- Juyoung Park
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of 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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Seo J, Lee JW, Kang Y, Lee E, Ahn JM, Kim DH, Kang HS. Evaluation of the responsiveness of outcome measures after spine injection: A retrospective study. PLoS One 2019; 14:e0211763. [PMID: 30811428 PMCID: PMC6392275 DOI: 10.1371/journal.pone.0211763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/27/2017] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
Discrepancies in patients’ responses to various outcome measures challenge clinicians’ evaluation of treatment outcomes. Therefore, we aimed to 1) evaluate the concordance of outcome measures after spine injection, 2) determine the patient variables that lead to discordant responses, and 3) suggest practical outcome measure for spine injections with good responsiveness. From October 2014 to November 2014, 164 patients with neck or low back pain who visited our outpatient clinics and had spine injections on the previous visit were enrolled. We asked patients to report changes in their symptom in the form of outcome measures: numeric rating scale, Oswestry disability index, neck disability index, residual symptom percentage and global perceived effect. The responses were categorized into three groups according to the degree of change; not improved, minimally improved, and significantly improved. The concordances of these categorized answers were evaluated. When “significantly improved” was considered as true improvement, 46 (28%) of the 164 patients had discordant responses to the four measures. There was no significant patients’ variable that affects discordance in the outcome measures. Good agreement was shown between the global perceived effect and residual symptom percentage, while the Oswestry disability index had poor agreement with the other measurements. The calculated numeric rating scale and residual symptom percentage also had low levels of agreement. However, patients with severe pre-treatment pain tended to have better agreement. In conclusion, this result suggest that the residual symptom percentage may be a more practical for clinicians and better represent patients’ improvements after spine injection.
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Affiliation(s)
- Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- * E-mail:
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Park C, Lee E, Yeo Y, Kang Y, Lee JW, Ahn JM, Kang HS. Spine MR images in patients with pedicle screw fixation: Comparison of conventional and SEMAC-VAT sequences at 1.5 T. Magn Reson Imaging 2018; 54:63-70. [PMID: 30099060 DOI: 10.1016/j.mri.2018.08.002] [Citation(s) in RCA: 3] [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] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Slice-encoding metal artifact corrections (SEMAC)-view-angle tilting (VAT) sequences have recently been used in clinical protocols to reduce metal artifacts in MR scans of patients with spinal instrumentation. The objective of this study was to compare the SEMAC-VAT sequence with the conventional MR sequence with a low bandwidth turbo-spin echo (TSE) in terms of image quality, visibility of periprosthetic structures, and diagnostic confidence for detection of postoperative complications in patients who underwent pedicle screw fixation at 1.5 T. METHODS Seventy patients who underwent pedicle screw fixation between the thoracic vertebrae and the sacrum were included in the study. The MR scans were retrospectively evaluated by two radiologists for signal-to-noise ratio of anatomical structures and size of artifacts, visibility of periprosthetic anatomical structures, and diagnostic confidence for detection of postoperative complications on conventional TSE and on SEMAC-VAT images. Paired t-tests and Wilcoxon signed-rank tests were used for comparisons, and kappa values were used for inter-observer agreement. RESULTS SEMAC-VAT images demonstrated significantly fewer metal artifacts, providing improved delineation of most periprosthetic anatomical structures and higher diagnostic confidence for detection of postoperative complications compared with conventional TSE images (p < 0.001). For the spinal canal, however, the visibility of anatomical structures and diagnostic confidence for detection of postoperative complications were better for conventional TSE than for SEMAC-VAT imaging (p < 0.001). CONCLUSION In conclusion, although SEMAC-VAT can significantly reduce metal artifact and provide improved delineation of periprosthetic anatomical structures compared to conventional TSE images, TSE is better for spinal canal evaluation. Therefore, it is important to understand the advantages and disadvantages of SEMAC-VAT and to use it properly.
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Affiliation(s)
- Chankue Park
- Department of Radiology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsananam-do, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Yujin Yeo
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Kang Y, Lee E, Lee JW, Kim SR, Kang MJ, Choi YW, Ahn JM, Kang Y, Kang HS. Effect of Poly(Lactide-Co-Glycolide) Nanoparticles on Local Retention of Fluorescent Material: An Experimental Study in Mice. Korean J Radiol 2018; 19:950-956. [PMID: 30174485 PMCID: PMC6082767 DOI: 10.3348/kjr.2018.19.5.950] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/29/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Poly(lactide-co-glycolide) (PLGA) nanoparticles are promising materials for the development of new drug-releasing systems. The purpose of this study was to evaluate the in vivo retention time of materials loaded in nanoparticles as compared with that of the material alone by in vivo imaging in nude mice. Materials and Methods Mice (n = 20) were injected with 0.1 mL fluorescent material 1,1'-dioctadecyl-3,3,3',3' tetramethylindotricarbocyanine iodide (DiR)-loaded PLGA nanoparticles (200 nm) into the right paraspinal muscle, and the same volume of pure DiR solution was injected into the left paraspinal muscle. Fluorescence images were obtained using an in vivo optical imaging system. Fluorescent images were taken 1 day after the injection, and seven more images were taken at 1-week intervals. Image analysis was done with ImageJ program, and one region of interest was chosen manually, which corresponded to the highest signal-intensity area of fluorescence signal intensity. Results After 7 weeks, 12 mice showed a right-sided dominant signal, representing the DiR loaded PLGA nanoparticles; 5 mice showed a left-side dominant signal, representing the free DiR solution; and 3 mice showed no signal at all beginning 1 day after the injection. During the 7-week period, the mean signal intensities of the free DiR solution and DiR-loaded PLGA nanoparticles diverged gradually. On day 1, the mean signal intensity of free DiR solution was significantly higher than that of DiR-loaded PLGA (p < 0.001). Finally, by week 7, DiR-loaded PLGA express significantly high signal intensity compared with free DiR solution (p = 0.031). Conclusion The results of the current study suggested that therapeutic agents bound to PLGA nanoparticles may exhibit prolonged retention times.
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Affiliation(s)
- Yeonah Kang
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Hospital, Seoul 07061, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sung Rae Kim
- College of Pharmacy, Chung-Ang University, Seoul 06911, Korea
| | - Myung Joo Kang
- College of Pharmacy, Dankook University, Cheonan 31116, Korea
| | - Young Wook Choi
- College of Pharmacy, Chung-Ang University, Seoul 06911, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Park C, Ahn JM, Kim H, Kang Y, Lee E, Lee JW, Kang HS. MRI analysis of extra-capsular ganglia at the gastrocnemius origin and their association with osteoarthritis. Clin Radiol 2018; 73:835.e17-835.e25. [PMID: 29910017 DOI: 10.1016/j.crad.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the prevalence, clinical relevance, and magnetic resonance imaging (MRI) features of extra-capsular ganglia at the gastrocnemius origin and to assess their association with internal derangement and osteoarthritis of the knee. MATERIALS AND METHODS One hundred consecutive knee MRI examinations, obtained within a 6-month period from patients with no history of recent knee trauma, recent injections, inflammatory arthritis, infection, or tumours, were evaluated retrospectively for the presence of ganglia at the gastrocnemius origin. The lesions were divided into two groups: an intra-capsular and an extra-capsular group. Cyst morphology (size, shape, and internal septa), internal derangement of the knee (cartilage lesion, cruciate ligament injury, meniscal tear, and corner injury on MRI, and osteoarthritis of the knee on radiographs) were evaluated. The chi-square, Fisher's exact, and t-tests were used to compare the two groups, in addition to multivariate stepwise logistic regression analysis. RESULTS Thirty-nine ganglia with an extra-capsular location were identified on 100 knee MRI (39 %). Rounded shape and internal septa were more common in the extra-capsular than in the intra-capsular group (p<0.001). Frequencies of high-grade cartilage, meniscal tear, and high-grade osteoarthritis significantly differed between the groups (p≤0.038). In multivariate analysis, the only significant association was between high-grade osteoarthritis and the extra-capsular group. CONCLUSION Extra-capsular ganglia at the gastrocnemius origin were not uncommon on knee MRI and had features typical of ganglia found at other sites. High-grade osteoarthritis was significantly associated with extra-capsular ganglia.
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Affiliation(s)
- C Park
- Department of Radiology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsananam-do, South Korea
| | - J M Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
| | - H Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Y Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - E Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - J W Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - H S Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
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Lee H, Ahn JM, Kang Y, Oh JH, Lee E, Lee JW, Kang HS. Evaluation of the Subscapularis Tendon Tears on 3T Magnetic Resonance Arthrography: Comparison of Diagnostic Performance of T1-Weighted Spectral Presaturation with Inversion-Recovery and T2-Weighted Turbo Spin-Echo Sequences. Korean J Radiol 2018. [PMID: 29520190 PMCID: PMC5840061 DOI: 10.3348/kjr.2018.19.2.320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the T1-weighted spectral presaturation with inversion-recovery sequences (T1 SPIR) with T2-weighted turbo spin-echo sequences (T2 TSE) on 3T magnetic resonance arthrography (MRA) in the evaluation of the subscapularis (SSC) tendon tear with arthroscopic findings as the reference standard. Materials and Methods This retrospective study included 120 consecutive patients who had undergone MRA within 3 months between April and December 2015. Two musculoskeletal radiologists blinded to the arthroscopic results evaluated T1 SPIR and T2 TSE images in separate sessions for the integrity of the SSC tendon, examining normal/articular-surface partial-thickness tear (PTTa)/full-thickness tear (FTT). Diagnostic performance of T1 SPIR and T2 TSE was calculated with arthroscopic results as the reference standard, and sensitivity, specificity, and accuracy were compared using the McNemar test. Interobserver agreement was measured with kappa (κ) statistics. Results There were 74 SSC tendon tears (36 PTTa and 38 FTT) confirmed by arthroscopy. Significant differences were found in the sensitivity and accuracy between T1 SPIR and T2 TSE using the McNemar test, with respective rates of 95.9–94.6% vs. 71.6–75.7% and 90.8–91.7% vs. 79.2–83.3% for detecting tear; 55.3% vs. 31.6–34.2% and 85.8% vs. 78.3–79.2%, respectively, for FTT; and 91.7–97.2% vs. 58.3–61.1% and 89% vs. 78–79.3%, respectively, for PTTa. Interobserver agreement for T1 SPIR was almost perfect for T1 SPIR (κ = 0.839) and substantial for T2 TSE (κ = 0.769). Conclusion T1-weighted spectral presaturation with inversion-recovery sequences is more sensitive and accurate compared to T2 TSE in detecting SSC tendon tear on 3T MRA.
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Affiliation(s)
- Hoseok Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Yoo HJ, Hong SH, Oh HY, Choi JY, Chae HD, Ahn JM, Kang HS. Diagnostic Accuracy of a Fluid-attenuated Inversion-Recovery Sequence with Fat Suppression for Assessment of Peripatellar Synovitis: Preliminary Results and Comparison with Contrast-enhanced MR Imaging. Radiology 2017; 283:769-778. [DOI: 10.1148/radiol.2016160155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kang Y, Lee GY, Lee JW, Lee E, Kim B, Kim SJ, Ahn JM, Kang HS. Texture Analysis of Torn Rotator Cuff on Preoperative Magnetic Resonance Arthrography as a Predictor of Postoperative Tendon Status. Korean J Radiol 2017; 18:691-698. [PMID: 28670164 PMCID: PMC5447645 DOI: 10.3348/kjr.2017.18.4.691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 01/31/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate texture data of the torn supraspinatus tendon (SST) on preoperative T2-weighted magnetic resonance arthrography (MRA) using the gray-level co-occurrence matrix (GLCM) for prediction of post-operative tendon state. MATERIALS AND METHODS Fifty patients who underwent arthroscopic rotator cuff repair for full-thickness tears of the SST were included in this retrospective study. Based on 1-year follow-up, magnetic resonance imaging showed that 30 patients had intact SSTs, and 20 had rotator cuff retears. Using GLCM, two radiologists measured independantly the highest signal intensity area of the distal end of the torn SST on preoperative T2-weighted MRA, which were compared between two groups.The relationships with other well-known prognostic factors, including age, tear size (anteroposterior dimension), retraction size (mediolateral tear length), grade of fatty degeneration of the SST and infraspinatus tendon, and arthroscopic fixation technique (single or double row), also were evaluated. RESULTS Of all the GLCM features, the retear group showed significantly higher entropy (p < 0.001 and p = 0.001), variance (p = 0.030 and 0.011), and contrast (p = 0.033 and 0.012), but lower angular second moment (p < 0.001 and p = 0.002) and inverse difference moment (p = 0.027 and 0.027), as well as larger tear size (p = 0.001) and retraction size (p = 0.002) than the intact group. Retraction size (odds ratio [OR] = 3.053) and entropy (OR = 17.095) were significant predictors. CONCLUSION Texture analysis of torn SSTs on preoperative T2-weighted MRA using the GLCM may be helpful to predict postoperative tendon state after rotator cuff repair.
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Affiliation(s)
- Yeonah Kang
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Guen Young Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea.,Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Bohyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea.,Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin 17035, Korea
| | - Su Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea.,Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Kang WY, Ahn JM, Lee JW, Lee E, Bae YJ, Seo J, Kim J, Kang HS. Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis? Acta Radiol 2017; 58:197-203. [PMID: 27055917 DOI: 10.1177/0284185116639766] [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] [Indexed: 11/17/2022]
Abstract
Background Both multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are used for assessment of lumbar foraminal stenosis (LFS). Therefore, it is relevant to assess agreement between these imaging modalities. Purpose To determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI. Material and Methods A total of 120 foramina in 20 patients who visited our institution in January and February 2014 were evaluated by six radiologists with different levels of experience. Radiologists evaluated presence and severity of LFS on sagittal CT and MR images according to a previously published LFS grading system. Intermodality agreement was analyzed by using weighted kappa statistics, while inter- and intra-observer agreement were analyzed by using intraclass correlation coefficients (ICCs) and kappa statistics. Results Overall intermodality agreement was moderate to good (kappa, 0.478-0.765). In particular, two professors and one fellow tended to overestimate the degree of LFS on CT compared with MRI. For inter-observer agreement of all six observers, ICCs indicated excellent agreement for both CT (0.774) and MRI (0.771), while Fleiss' kappa values showed moderate agreement for CT (0.482) and MRI (0.575). There was better agreement between professors and fellows compared with residents. For intra-observer agreement, ICCs indicated excellent agreement, while kappa values showed good to excellent agreement for both CT and MRI. Conclusion MDCT was comparable to MRI for diagnosis and assessment of LFS, especially for experienced observers. However, there was a tendency to overestimate the degree of LFS on MDCT compared with MRI.
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Affiliation(s)
- Woo Young Kang
- Department of Radiology, Chungbuk National University Hospital, Chungbuk, Republic of Korea
| | - Joong Mo Ahn
- 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
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Junghoon Kim
- 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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Abstract
Advances in imaging and the development of injection techniques have enabled spinal intervention to become an important tool in managing chronic spinal pain. Epidural steroid injection (ESI) is one of the most widely used spinal interventions; it directly delivers drugs into the epidural space to relieve pain originating from degenerative spine disorders-central canal stenoses and neural foraminal stenoses-or disk herniations. Knowledge of the normal anatomy of the epidural space is essential to perform an effective and safe ESI and to recognize possible complications. Although computed tomographic (CT) or combined CT-fluoroscopic guidance has been increasingly used in ESI, conventional fluoroscopic guidance is generally performed. In ESI, drugs are delivered into the epidural space by interlaminar or transforaminal routes in the cervical spine or by interlaminar, transforaminal, or caudal routes in the lumbar spine. Epidurography is usually performed before drug delivery to verify the proper position of the needle in the epidural space. A small amount of contrast agent is injected with fluoroscopic guidance. Familiarity with the findings on a typical "true" epidurogram (demonstrating correct needle placement in the epidural space) permits proper performance of ESI. Findings on "false" epidurograms (demonstrating incorrect needle placement) include muscular staining and evidence of intravascular injection, inadvertent facet joint injection, dural puncture, subdural injection, and intraneural or intradiscal injection. ©RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2016.
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Affiliation(s)
- Euddeum Shim
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Joon Woo Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Eugene Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Joong Mo Ahn
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Yusuhn Kang
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Heung Sik Kang
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
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Lee E, Lee JW, Lee J, Lee GY, Kang WY, Yoo BR, Shin YJ, Ahn JM, Kang HS. Acute benign vertebral compression fractures: "see-through sign" on contrast-enhanced MR images. Eur Spine J 2016; 25:3470-3477. [PMID: 26538157 DOI: 10.1007/s00586-015-4312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To retrospectively evaluate the diagnostic role of the contrast-enhanced MRI (CE-MRI) for differentiation between benign VCFs and malignant VCFs focusing on the internal transparent trabecular bone on CE-MRI (the "see-through sign"). MATERIALS AND METHODS The institutional review board approved this study and informed consent was waived due to the retrospective nature of the study. From January 2012 to December 2013, all 149 consecutive benign or malignant VCF patients were enrolled for consideration in this study from a CE-MRI database. In the first analysis, four radiologists independently evaluated the presence or absence of the see-through sign. The see-through sign was defined as internal transparent trabecular bone morphology on CE-MRI. The intraclass correlation coefficient (ICC), percentage agreement, and Fleiss's kappa statistics were obtained. RESULTS Fifty-seven patients (M:F = 27:30; mean age, 63 years; age range, 20-88 years) who diagnosed as acute benign (n = 24) and malignant (n = 33) VCFs were finally included for the analysis. The results of all readers showed that the see-through sign was associated with acute benign VCFs (p < 0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the see-through sign ranged from 75-96, 70-88, 66-85, 81-97 %, respectively. The inter-observer reliability of the see-through sign was sufficient with ICC = 0.847, percentage agreement = 78.9, and κ = 0.578. CONCLUSION The see-through sign on CE-MRI is featured in acute benign VCFs, and it can be a useful finding to differentiate between benign and malignant VCFs.
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Affiliation(s)
- Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
| | - Jinyoung Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Guen Young Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Woo Young Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Bo Reum Yoo
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Yoon Joo Shin
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Yoo HJ, Hong SH, Kim DH, Choi J, Chae HD, Jeong BM, Ahn JM, Kang HS. Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging 2016; 45:1534-1544. [DOI: 10.1002/jmri.25496] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hye Jin Yoo
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Sung Hwan Hong
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
| | - Dong Hyun Kim
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Ja‐Young Choi
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Hee Dong Chae
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Bo Mi Jeong
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Joong Mo Ahn
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
| | - Heung Sik Kang
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
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Muhle C, Ahn JM, Biederer J, Schäfer FKW, Frahm CH, Mohr A, Brossmann J, Resnick D. MR imaging of the neural foramina of the cervical spine: Comparison of 3D-DESS and 3D-FISP sequences. Acta Radiol 2016; 43:96-100. [PMID: 11972470 DOI: 10.1080/028418502127347510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To assess whether a single three-dimensional double-echo steady state (3D-DESS) sequence can produce equivalent results when compared to a 3D free induction with steady precession (3D-FISP) sequence for the evaluation of the neural foraminal diameter and structures. Material and Methods: Five phantoms were imaged on CT with 3-mm axial slices followed by reformatted axial 3D-DESS and 3D-FISP sequences. In addition, 3D-DESS and 3D-FISP sequences of 20 healthy subjects were compared with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural foramina, and differentiation between vertebrae and neural foramina. Results: Compared with CT, 3D-DESS and 3D-FISP sequences consistently underestimated the diameters of the neural foramina. The mean difference values for the 3D-DESS was 12.8%, compared to 9.5% for the 3D-FISP sequence. Concerning the in vivo studies, the 3D-DESS sequence was superior but not statistical significant to the 3D-FISP sequence with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural formina, and identification of the nerve roots. Conclusion: The 3D-DESS sequence is moderately accurate in the evaluation of the neural foraminal size. Compared to the 3D-FISP sequence, the 3D-DESS sequence is compatible concerning the image quality, differentiation between the cervical vertebrae and discs, and between the discs and neural foramina.
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Affiliation(s)
- Claus Muhle
- Department of Nuclear Medicine, Christian-Albrechts University of Kiel, Arnold-Heller-Strasse 9, DE-24105 Kiel, Germany
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Lee BB, Mattassi R, Choe YH, Vaghi M, Ahn JM, Kim DI, Huh SH, Lee CH, Kim DY. Critical role of duplex ultrasonography for the advanced management of a venous malformation. Phlebology 2016. [DOI: 10.1258/0268355053300875] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: Duplex ultrasonography was assessed for its advanced role as a contemporary guide for the safer management of venous malformation (VM) at the lower extremities through a comparison study with matching magnetic resonance imaging (MRI) and/or ascending phlebography findings. Methods: A retrospective review of 50 patients with a VM in the lower extremities was performed using the duplex scan findings on the initial diagnosis and the subsequent follow-up assessment of the treatment response. The screening findings of deep vein thrombosis (DVT) development following ethanol sclerotherapy on 40 patients were also included. A marginal vein (lateral embryonal) compression test was also performed on 10 patients, who were candidates for a resection preoperatively, in order to assess its value in predicting the response to the subsequent resection. The duplex scan findings were compared with the available ascending phlebography results in 38 patients, and also with the MRI findings available for all 50 patients. Results: The duplex scan on the 50 patients confirmed the existence of a normal deep vein system in the lower extremities in 43 patients as the true-positive test findings. One false-negative test finding was subsequently confirmed by an angiographic evaluation. The duplex scan also confirmed the absence of a normal deep vein system in four patients as a true-negative test. MRI subsequently confirmed two false-positive findings in one patient, and angiography confirmed two false-positive findings in another (sensitivity − 97.8%, specificity − 66.7%, positive predictive value − 95.6%, and negative predictive value − 80%). Among a total of 40 patients who received ethanol sclerotherapy, the duplex scan identified DVT in three patients, and also screened out properly in 37 patients through a total of 185 ethanol sclerotherapy sessions. The compression test predicted the surgical outcome successfully in the majority (7/8). The duplex scan appears to have comparable reliability to MRI and/or angiography for diagnosing and managing VM. Conclusions: The duplex scan can provide the critical haemodynamic information of both the deep venous system and VM lesions quite effectively with the cost-effectiveness of a non-invasive test. In particular, the duplex scan is an excellent test for the safe management of VM of the lower extremity, including the early detection of DVT through multi-session ethanol sclerotherapy.
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Affiliation(s)
- B B Lee
- Department of Surgery & Vascular Center, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - R Mattassi
- Department of Surgery & CVM Center, G. Salvini Hospital, Milan, Italy
| | - Y H Choe
- Department of Radiology, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - M Vaghi
- Department of Surgery & CVM Center, G. Salvini Hospital, Milan, Italy
| | - J M Ahn
- Department of Radiology, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - D I Kim
- Department of Surgery & Vascular Center, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - S H Huh
- Department of Surgery & Vascular Center, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - C H Lee
- Department of Surgery & Vascular Center, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
| | - D Y Kim
- Department of Surgery & Vascular Center, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea
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Kim S, Shin JH, Lee JW, Kang HS, Lee GY, Ahn JM. Factors Affecting Radiation Exposure during Lumbar Epidural Steroid Injection: A Prospective Study in 759 Patients. Korean J Radiol 2016; 17:405-12. [PMID: 27134528 PMCID: PMC4842859 DOI: 10.3348/kjr.2016.17.3.405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/09/2014] [Accepted: 01/26/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate and compare radiation exposure and intervention time during lumbar epidural steroid injection (ESI) 1) under different practitioners and methods with continuous fluoroscopic monitoring, and 2) under one practitioner with different methods and monitoring. MATERIALS AND METHODS We consecutively recruited 804 patients who underwent lumbar ESI and 759 patients who underwent 922 interventions were included for analysis in this investigation. Three different practitioners (a senior faculty member, junior faculty member, trainee) performed lumbar ESI using different methods (caudal, interlaminar, transforaminal). The senior faculty member performed lumbar ESI under two different methods of fluoroscopic monitoring (continuous [CM] and intermittent monitoring [IM]). The dose area product (DAP) fluoroscopy time, and intervention time during lumbar ESI were compared for 1) ESI methods and practitioners under CM, and 2) ESI methods and monitoring. RESULTS With CM, interaction between the effects of the practitioner and the intervention on DAP was significant (p < 0.001), but not fluoroscopy time (p = 0.672) or intervention time (p = 0.852). The significant main effects included the practitioner and intervention on DAP, fluoroscopy time, and intervention time with CM (p < 0.001). DAPs and fluoroscopy time for caudal, interlaminar, and transforaminal ESI were higher with CM than with IM (p < 0.001). Intervention time did not differ between CM and IM. CONCLUSION Radiation exposure is dependent on the practitioners and methods and within the established safety limits during lumbar ESIs under CM. With an experienced practitioner, IM leads to less radiation exposure than CM.
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Affiliation(s)
- Suyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
- Department of Law, Hanyang University, Seoul 04763, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation, National Rehabilitation Center, Seoul 01022, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Guen Young Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Choi SW, Ahn JM, Lee JW, Park KS, Kang HS. The usefulness of MDCT-myelography for patients with spontaneous intracranial hypotension. Springerplus 2016; 5:424. [PMID: 27104112 PMCID: PMC4828345 DOI: 10.1186/s40064-016-2060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/27/2016] [Indexed: 11/10/2022]
Abstract
Purpose The detection and localization of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH) is important. The aim of this study was to evaluate the usefulness of multidetector CT (MDCT)-myelography in patients with SIH. Methods A radiologist retrospectively searched the electronic database to find the patients who had undergone MDCT-myelography for SIH between October 2010 and September 2014. In the MDCT-myelographic treatment, the patient’s whole spine was scanned by 64 or 256 channel MDCT scanners after being injected with 20 ml of contrast agent via L3/4 interlaminar space under fluoroscopic guidance. Three radiologists in consensus determined the presence, pattern (“pseudodiverticular sign” or “gray-rim sign”) and level of contrast leakage outside the dural sac. Results Eighteen patients (M:F = 9:9; mean age, 36.2; age range 17–56) were finally included in this study. CSF leakage was detected in 17 of 18 patients. CSF leakage pattern was described as a “pseudodiverticular sign” in five and “gray-rim sign” in ten patients. Leakage level could be determined in ten patients based on MDCT-myelography. Conclusions MDCT-myelography was useful to detect CSF leakage and to guess the leakage level in patients with SIH.
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Affiliation(s)
- Seung Woo Choi
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeongi-do 13620 South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeongi-do 13620 South Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeongi-do 13620 South Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Gyeongi-do 13620 South Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeongi-do 13620 South Korea
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Im TS, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures. Cardiovasc Intervent Radiol 2015; 39:740-745. [DOI: 10.1007/s00270-015-1286-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
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Kim S, Lee JW, Chai JW, Yoo HJ, Kang Y, Seo J, Ahn JM, Kang HS. A New MRI Grading System for Cervical Foraminal Stenosis Based on Axial T2-Weighted Images. Korean J Radiol 2015; 16:1294-302. [PMID: 26576119 PMCID: PMC4644751 DOI: 10.3348/kjr.2015.16.6.1294] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 01/02/2015] [Accepted: 07/17/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the reliability of a new magnetic resonance imaging (MRI) grading system for cervical neural foraminal stenosis (NFS). MATERIALS AND METHODS Cervical NFS at bilateral C4/5, C5/6, and C6/7 was classified into the following three grades based on the T2-weighted axial images: Grade 0 = absence of NFS, with the narrowest width of the neural foramen greater than the width of the extraforaminal nerve root (EFNR); Grade 1 = the narrowest width of the neural foramen the same or less than (but more than 50% of) the width of the EFNR; Grade 2 = the width of the neural foramen the same or less than 50% of the width of the EFNR. The MRIs of 96 patients who were over 60 years old (M:F = 50:46; mean age 68.4 years; range 61-86 years) were independently analyzed by seven radiologists. Interobserver and intraobserver agreements were analyzed using the percentage agreement, kappa statistics, and intraclass correlation coefficient (ICC). RESULTS For the distinction among the three individual grades at all six neural foramina, the ICC ranged from 0.68 to 0.73, indicating fair to good reproducibility. The percentage agreement ranged from 60.2% to 70.6%, and the kappa values (κ = 0.50-0.58) indicated fair to moderate agreement. The percentages of intraobserver agreement ranged from 85.4% to 93.8% (κ = 0.80-0.92), indicating near perfect agreement. CONCLUSION The new MRI grading system shows sufficient interobserver and intraobserver agreement to reliably assess cervical NFS.
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Affiliation(s)
- Sujin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Joong Mo Ahn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
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Aluthge DC, Ahn JM, Mehrkhodavandi P. Overcoming aggregation in indium salen catalysts for isoselective lactide polymerization. Chem Sci 2015; 6:5284-5292. [PMID: 29449930 PMCID: PMC5669251 DOI: 10.1039/c5sc01584g] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/20/2015] [Indexed: 11/30/2022] Open
Abstract
A methodology for controlling aggregation in highly active and isoselective indium catalysts for the ring opening polymerization of racemic lactide is reported. A series of racemic and enantiopure dinuclear indium ethoxide complexes bearing salen ligands [(ONNOR)InOEt]2 (R = Br, Me, admantyl, cumyl, t-Bu) were synthesized and fully characterized. Mononuclear analogues (ONNOR)InOCH2Pyr (R = Br, t-Bu, SiPh3) were synthesized by controlling aggregation with the use of chelating 2-pyridinemethoxide functionality. The nuclearity of metal complexes was confirmed using PGSE NMR spectroscopy. Detailed kinetic studies show a clear initiation period for these dinuclear catalysts, which is lacking in their mononuclear analogues. The polymerization behavior of analogous dinuclear and mononuclear compounds is identical and consistent with a mononuclear propagating species. The isotacticity of the resulting polymers was investigated using direct integration and peak deconvolution methodologies and the two were compared.
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Affiliation(s)
- D C Aluthge
- Department of Chemistry , University of British Columbia , 2036 Main Mall , Vancouver , BC V6T 1Z1 , Canada .
| | - J M Ahn
- Department of Chemistry , University of British Columbia , 2036 Main Mall , Vancouver , BC V6T 1Z1 , Canada .
| | - P Mehrkhodavandi
- Department of Chemistry , University of British Columbia , 2036 Main Mall , Vancouver , BC V6T 1Z1 , Canada .
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