Doo Kyoung Kang

Ajou University, Sŏul, Seoul, South Korea

Are you Doo Kyoung Kang?

Claim your profile

Publications (36)75.84 Total impact

  • Seon Young Park, Doo Kyoung Kang, Tae Hee Kim
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The purpose of our study was to evaluate whether strong background parenchymal enhancement would be a significant independent factor associated with positive resection margin in patients treated initially with breast conserving surgery. Materials and Methods: Retrospective evaluation of breast MRI examinations of 314 patients with breast cancer was done. Breast cancer was histologically confirmed in all patients who underwent breast conserving surgery from January 2008 to December 2010. Background parenchymal enhancement was dichotomized into weak (minimal or mild) and strong (moderate or marked) enhancement for statistical analysis. Histopathologic features of attained specimens were evaluated by an experienced pathologist and were also dichotomized for statistical analysis. Results: On univariate analysis, positive extensive intraductal component (p<0.001), strong background parenchymal enhancement (p=0.001), and HER2 positivity (p=0.08) had significant association with positive surgical margin. Tumour size, axillary lymph node metastasis, nuclear grade, histologic grade, lymphovascular invasion, estrogen receptor and progesterone receptor did not show significant correlation with positive surgical margin. On multivariate analysis, the significant independent predictors were extensive intraductal component (Odds ratio 5.68; 95% CI 2.72-11.82) and strong background parenchymal enhancement (Odds Ratio 2.39; 95% CI 1.2-4.78). Conclusion: Strong background parenchymal enhancement is significant independent factor for positive resection margin along with positive extensive intraductal component, and performing MRI during the period of lower parenchymal enhancement is needed in patients with strong background parenchymal enhancement. Advances in knowledge: As far as we know, this is the first study to reveal that BPE is a significant independent factor associated with positive resection margin.
    The British journal of radiology. 11/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: To find out any correlation between dynamic contrast-enhanced (DCE) model-based parameters and model-free parameters, and evaluate correlations between perfusion parameters with histologic prognostic factors. Model-based parameters (Ktrans, Kep and Ve) of 102 invasive ductal carcinomas were obtained using DCE-MRI and post-processing software. Correlations between model-based and model-free parameters and between perfusion parameters and histologic prognostic factors were analysed. Mean Kep was significantly higher in cancers showing initial rapid enhancement (P = 0.002) and a delayed washout pattern (P = 0.001). Ve was significantly lower in cancers showing a delayed washout pattern (P = 0.015). Kep significantly correlated with time to peak enhancement (TTP) (ρ = -0.33, P < 0.001) and washout slope (ρ = 0.39, P = 0.002). Ve was significantly correlated with TTP (ρ = 0.33, P = 0.002). Mean Kep was higher in tumours with high nuclear grade (P = 0.017). Mean Ve was lower in tumours with high histologic grade (P = 0.005) and in tumours with negative oestrogen receptor status (P = 0.047). TTP was shorter in tumours with negative oestrogen receptor status (P = 0.037). We could acquire general information about the tumour vascular physiology, interstitial space volume and pathologic prognostic factors by analyzing time-signal intensity curve without a complicated acquisition process for the model-based parameters. • Kep mainly affected the initial and delayed curve pattern in time-signal intensity curve. • There is significant correlation between model-based and model-free parameters. • We acquired information about tumour vascular physiology, interstitial space volume and prognostic factors.
    European Radiology 02/2014; · 4.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To investigate the prevalence of simple pulmonary eosinophilia (SPE) and validate CT findings of SPE found on follow-up CT of oncologic patients Methods We retrospectively reviewed 6977 cases of oncologic patients who underwent chest CT. A total of 66 individuals who met criteria for having SPE were identified. CT scans were fully re-assessed by consensus of 2 radiologists in terms of characteristics of pulmonary lesions. Results The prevalence of SPE was 0.95%. A total of 193 lesions were identified and most of the lesions showed part-solid pattern (69.9%), round to ovoid contour (46.1%), ill-defined margin (90.2%), or partial halo appearance (74.8%). In addition, almost half of the lesions showed the vascular contact (49%). SPE appeared as either solitary (42.4%) or multiple lesions (57.6%). The majority of lesions were located in the periphery (76.2%), and lower lung zonal (67.4%) predominance was found. Conclusions The frequency of SPE in oncologic patients with CT findings of GGO, part-solid lesion was high (17.5%). Therefore, when key features of CT findings suggesting SPE (part-solid nodule; ill-defined margin; peripheral distribution; and lower lung zone predominance) are newly discovered on follow-up chest CT in oncologic patients, it would be useful to correlate with blood test and do short-term follow-up in order to avoid unnecessary invasive procedure.
    European Journal of Radiology. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE. The purpose of this study was to validate the usefulness of MDCT for diagnosis of a sharp or pointed esophageal foreign body according to esophageal level. MATERIALS AND METHODS. Forty-two patients with a history of sharp or pointed foreign body ingestion were reviewed retrospectively. Two observers interpreted the CT and the conventional radiography datasets separately. If a foreign body was directly identified, it was regarded as a positive finding. Even if no high-density foreign body was found, detection of a secondary finding was considered to be a positive finding. Diagnostic performance of MDCT and conventional radiography were compared according to esophageal level. Final diagnosis was made by esophagoscopy or surgery in addition to the clinicoradiologic result. RESULTS. MDCT was statistically superior to conventional radiography for diagnosis of a thoracic esophageal foreign body for both observers (p < 0.001 for each). No significant difference in sensitivity between CT and conventional radiography for diagnosis of cervical esophageal foreign body was noted regardless of observer. Both observers could identify all complicated conditions with MDCT regardless of esophageal level. However, in two of three cases of complicated thoracic esophageal foreign bodies, neither observer could detect foreign bodies on conventional radiography; furthermore, the observers could not identify pneumomediastinum. CONCLUSION. In cases of sharp or pointed foreign body ingestion, if the result of an initial inspection of oro- and hypopharynx reveals negative findings, the first imaging modality should be MDCT for better diagnosis and management.
    American Journal of Roentgenology 11/2013; 201(5):W707-11. · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: MRI and PET/CT are useful for assessing breast cancer patients after neoadjuvant chemotherapy (NAC). To investigate the utility of MRI and PET/CT in the prediction of pathologic response to neoadjuvant chemotherapy using Miller-Payne grading system in patients with breast cancer. From January 2008 to December 2010, 59 consecutive patients with pathologically proven breast cancer, who underwent neoadjuvant chemotherapy followed by surgery were retrospectively enrolled. The maximal diameter decrease rate and volume reduction rate by three-dimensional (3D) MRI and standardized uptake value (SUV) reduction rate by PET/CT were calculated and correlated with the Miller-Payne grading system using the Spearman rank correlation test. Patients with Miller-Payne grades 1 or 2 were classified into the non-responder group and patients with grades 3, 4, and 5 were in the responder group. To differentiate between responders and non-responders, receiver-operating characteristic (ROC) analysis was performed. The volume reduction rate was 64.87 ± 46.95, diameter decrease rate was 48.09 ± 35.02, and SUV decrease rate was 62.10 ± 32.17. Among three parameters, the volume reduction rate was most correlated with histopathologic grades of regression (ρ = 0.755, P <0.0001) followed by diameter decrease rate (ρ = 0.660, P < 0.0001), and SUV decrease rate of primary breast mass (ρ = 0.561, P = 0.0002). The area under the ROC curve (Az) value was largest in the volume reduction rate (Az = 0.9), followed by SUV decrease rate (Az = 0.875), and diameter decrease rate (Az = 0.849). The best cut-offs for differentiating responders from non-responders in the ROC curve analysis were a 50% decrease in diameter, 68.9% decrease in volume, and 60.1% decrease in SUV after NAC. Volumetric measurement using 3D MRI combined with conventional diameter measurement may be more accurate to evaluate pathologic response after NAC.
    Acta Radiologica 08/2013; · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neoadjuvant chemotherapy is the standard treatment for patients with locally advanced breast cancer and is increasingly considered for patients with operable disease. Recently, as many clinical trials have demonstrated favorable outcomes of anthracycline-taxane based regimen, this approach has been widely used in the neoadjuvant setting. We compared women who received adriamycine and docetaxel (AD) with adriamycin, cyclophosphamide followed by paclitaxel (AC-T) as neoadjuvant chemotherapy. The AD group was scheduled for six cycles of AD (50 mg/m(2) and 75 mg/m(2), respectively) at a 3-week interval. The AC-T group was scheduled for four cycles of adriamycin and cyclophosphamide (50 mg/m(2) and 500 mg/m(2), respectively) followed by four cycles of paclitaxel (175 mg/m(2)) at a 3-week interval. The responses of chemotherapy were equivalent (overall response rate [AD, 75.7% vs. AC-T, 80.9%; P = 0.566], pathologic complete response [pCR] rate [breast and axilla: AD, 10.8% vs. AC-T, 12.8%; P = 1.000; breast only: AD, 18.9% vs. AC-T, 14.9%, P = 0.623], breast conserving surgery rate [P = 0.487], and breast conserving surgery conversion rate [P = 0.562]). The pCR rate in the breast was higher in the human epidermal growth factor receptor 2 (HER2) positive cases (HER2 positive 33.3% vs. negative 10%, P = 0.002). Although nonhematologic toxicities were comparable, hematologic toxicities were more severe in the AD group. Most women in the AD group suffered from grade 3/4 neutropenia (P < 0.001) and neutropenic fever (P < 0.001). Tumor responses were not different in various variables between the two groups. However, AC-T was a more tolerable regimen than AD in patients with breast cancer receiving neoadjuvant chemotherapy.
    Journal of the Korean Surgical Society 07/2013; 85(1):7-14. · 0.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Granulocytic sarcoma is a localized extramedullary solid tumor composed of immature myeloid cell and is usually associated with acute myeloid leukemia or myelodysplastic syndrome. Although it can involve any site, commonly in lymph nodes, skin, bone and soft tissue, the involvement of breast is unusual. Especially, the involvement of the breast as a pattern of relapse after bone marrow transplantation is extremely rare. We have experienced 2 cases of granulocytic sarcoma after bone marrow transplantation. One case was a 39-year-old woman with right breast mass diagnosed with granulocytic sarcoma. She had received an unrelated bone marrow transplantation due to biphenotype acute leukemia 3 years before our presentation. Another case was a 48-year-old woman with acute myeloid leukemia, who was diagnosed with granulocytic sarcoma on both breasts 8 months after allogenic bone marrow transplantation. We also discuss the clinicopathologic features of granulocytic sarcoma in breast after bone marrow transplantation.
    Journal of Breast Cancer 03/2013; 16(1):112-116. · 0.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE We conducted a study to evaluate the usefulness of automatic tube current modulation(ATCM) in computed tomography (CT) of ultra (very) low-dose chest CT screening to decrease radiation dose without degradation of image quality. METHOD AND MATERIALS Ultra low-dose chest CT data from 60 subjects were acquired at 20mAs and 100kVp on a 64-row Multidetector CT scanner. Group 1 (30 subjects) underwent ultra low-dose chest CT with fixed tube current of 20mAs and group 2 (30 subjects) underwent ultra low-dose chest CT with ATCM of 20 mAs. There was no significant difference of body mass index in both groups (group 1=24.13+3.14 and group 2=24.35+4.32, p>0.05). Total of 60 data sets were randomly arranged to be evaluated. Radiologist blinded to current technique evaluated images. For radiation dose description, CT radiation dose descriptors were recorded following completion of the CT examination for all image data sets. Qualitative image noises (5-point scale), visibility of small structures (5-point scale) were assessed at lung apex, mid and base of lung, aorta, and liver. RESULTS Radiation dose of group 2 (ATCM) was significantly lower than that of group 1 (group 1= 31.64+2.0 and group 2=25.43+5.9, p<0.0001). However, subjective image noises in lung parenchyma and soft tissue were substantially lower in group 1 (fixed tube current) (p<005). Furthermore, in terms of visibility of small structures, fixed tube current technique was superior to ATCM technique for depicting small structure of lung (p<0.005). CONCLUSION In the application of ultra (very) low-dose chest CT, ATCM technique would not be adequate to keep image quality compared to fixed tube current technique. A larger study including more subjects is required to make the conclusion generalizable. CLINICAL RELEVANCE/APPLICATION This preliminary study suggests ATCM may be inadequate in ultra low-dose chest CT in two aspects: 1) degradation of subjective image quality 2) lower power to depict small structures of lung.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE To evaluate the progression of atherosclerotic plaque during the follow-up interval and to compare it with the cardiovascular risk profile. METHOD AND MATERIALS One hundred and sixty-seven patients underwent repeated 64-slice MDCT with mean interval of 2.2 ± 0.9 years. The progression of atherosclerotic plaque volume between baseline and follow-up was assessed for the lesion. Coronary lesions detected on MDCT were grouped according to plaque composition. Calcified plaque volume was measured using non-contrast calcium scoring examination. Non-calcified plaque volume was measured using contrast enhanced coronary CT angiography and a commercially available plaque analysis tool (Aquarius, TeraRecon). The National Cholesterol Education Program (NCEP) risk categories, calcified plaque volume and non-calcified plaque volume were compared between baseline and follow-up by using a paired t-test. Absolute and percentage changes of each plaque volume were also calculated, and compared each other by using Mann-Whitney test. RESULTS In the follow-up period, the total Agatston calcium score was significantly increased (15.3mm3 vs. 27.2mm3, p<0.001), whereas the NCEP risk categories were unchanged (p=0.058). The calcified plaque volume (13.7mm3 vs. 22.0 mm3, p<0.001), non-calcified plaque volume (46.3mm3 vs. 147.4mm3, p<0.001) and stenosis degree (30.4% vs. 39.5%, p<0.001) of the lesions were significantly increased on follow-up CT. Median plaque percentage change was greater(p=0.028) in fatty plaque(44.7%, 95% CI 19.9 – 229.6%) than in calcified plaque (29.8%, 95% CI 15.1 – 44.6%). CONCLUSION Coronary plaque burden significantly increased on follow-up CT, but the rate of progression was dependent on plaque composition and was greater for fatty plaque than for calcified plaque. CLINICAL RELEVANCE/APPLICATION Contrast-enhanced MDCT may be a reliable modality to evaluate the progression of coronary atherosclerotic plaque.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to compare adjacent vessel sign, increased ipsilateral whole-breast vascularity, and various MRI features as described in the American College of Radiology BI-RADS MRI lexicon with histopathologic predictors in patients with unilateral breast cancer. We retrospectively evaluated breast MRI examinations of 249 patients with histologically confirmed breast cancer. In addition to the BI-RADS MRI lexicon, the adjacent vessel sign and increased ipsilateral whole-breast vascularity of the cancer-bearing breast were evaluated by two independent observers. MRI features were then correlated with histopathologic prognostic factors. The adjacent vessel sign was significantly (p = 0.023 to p < 0.001) associated with tumor size, lymph node metastasis, distant metastasis, nuclear grade, and expression of estrogen and progesterone receptors. Increased ipsilateral whole-breast vascularity was significantly associated with all histopathologic predictors (p = 0.017 to p < 0.001). In multivariate analysis, the significant and independent predictors were a spiculated margin and rim enhancement for negative estrogen and progesterone receptors, a kinetic curve type for higher histologic grade, and an increased ipsilateral whole-breast vascularity for larger tumor size, lymph node metastasis, distant metastasis, higher nuclear grade, and higher histologic grade. In conjunction with the standard BI-RADS MRI lexicon, the adjacent vessel sign and increased ipsilateral whole-breast vascularity may serve as additional predictors of a poor prognosis.
    American Journal of Roentgenology 10/2012; 199(4):921-8. · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stratification of risk factors for cervical lymph node metastasis (LNM) in thyroid papillary carcinoma is important for providing standards for post-operative adjuvant radio-iodine therapy and for patient prognosis. We investigated pathological factors based on the lymphatic vessel system and radiological features associated with tumor with cervical neck LNM. Among patients who had undergone thyroidectomy confirmed to be papillary thyroid carcinoma, we selected 126 age-sex matched paired patients without cervical LNM (group 1) and with LNM (group 2) to evaluate risk factors. Pathological factors evaluated were size, multiplicity, and extra thyroid extension state, based on the pathological reports using stored data. The lymphatic vessel density (LVD) of each tumor was evaluated by staining for VEGFR-3 and D2-40 and correlated with cervical LNM state. Malignant ultrasound features were evaluated to compare the differences between these two groups. Larger tumor size, multiplicity, extrathyroid extension were more common in group 2 (p<0.05). The median percentage of VEGFR-3 for group 1 was 20 (range 0-30) and D2-40 was 13 (range 7-23) while for group 2, VEGFR-3 was 80 (70-90) and D2-40 was 78 (54-114). LVD measured by intratumoral D2-40 staining was 20.6% and 79.4% for group 1 and group 2, respectively. Intra-tumoral lymphatics measured by D2-40 stain had a strong correlation with cervical LNM (Odds 1.230, CI 1.01.-1.499 p value 0.040). US features had no significant differences between the two groups although calcifications tended to be higher in group 2 (84% vs 76% p=0.264). Lymphatic vessel density and nodule echogenicity were not associated with LNM. Intratumoral lymphangiogenesis was most strongly associated with LNM and thus, could be a useful predictive marker for cervical LNM.
    Endocrine Journal 06/2012; · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purposes of this study were to assess the clinical utility of sonography for evaluation of contralateral suspicious lesions detected on magnetic resonance imaging (MRI) in patients with breast cancer and to compare imaging findings of the index and synchronous contralateral cancers. We performed breast MRI on 853 consecutive patients with histologically confirmed breast cancer between January 2006 and December 2009. All patients underwent mammography and whole-breast sonography before MRI. We included 126 contralateral enhancing lesions in 98 patients who underwent second-look sonography. Lesions with sonographic correlation were biopsied using sonographic guidance, and lesions without sonographic correlation were biopsied using computed tomographic guidance or followed with imaging modalities. Of 126 suspicious lesions, 81 (64%) were correlated on sonography, and 45 (36%) were not. Of 81 correlated lesions, 16 (20%) were malignant, and 65 (80%) were benign. Of 45 lesions that were not correlated on sonography, only 1 (2%) was malignant. Of 17 contralateral cancers, 11 were detected on initial sonography and 5 on second-look sonography. The index and contralateral cancers showed statistically significant differences in the sonographic boundary (P = .003) and posterior echogenicity (P = .013). The contralateral cancers detected on initial or second-look sonography showed significant differences in the echo pattern (P = .001). Magnetic resonance imaging is a reliable tool for detection of occult contralateral breast cancer. With second-look sonography, we can find additional contralateral cancer. When enhancing lesions on MRI are not correlated on sonography, MRI- or computed tomography-guided biopsy or short-term imaging follow-up should be done.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2012; 31(6):903-13. · 1.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of the study were to analyze the tumor shrinkage pattern on magnetic resonance imaging (MRI) after neoadjuvant chemotherapy and to evaluate whether there is any difference in shrinkage pattern between pathological responder and nonresponder groups. In addition, we wanted to compare tumor diameter obtained from MRI with histological diameter according to the tumor shrinkage pattern. Between July 2008 and December 2010, 55 consecutive patients (56 lesions) with pathologically proven breast cancer who underwent neoadjuvant chemotherapy followed by surgery were retrospectively enrolled. The shrinkage pattern was classified into 4 categories: I (concentric shrinkage without surrounding lesion), II (concentric shrinkage with surrounding lesions), III (shrinkage with residual multinodular lesions, and IV (diffuse contrast enhancement in whole quadrants). Histological regression was scored on a 5-point scale regarding tumor cellularity reduction (Miller-Payne grading system). Patients with Miller-Payne grade 1 or 2 were classified into the nonresponder group, and patients with grade 3, 4, or 5 were in the responder group. Of 56 lesions, pattern I was seen in 29 lesions, pattern II in 13 lesions, pattern III in 5 lesions, and pattern IV in 4 lesions. Three lesions were not visualized on MRI after neoadjuvant chemotherapy, and 2 lesions were increased in size. There was a statistically significant difference in the tumor shrinkage pattern between responder and nonresponder groups (P = 0.017). All 5 lesions with type III shrinkage pattern were found in the responder group, and all 4 lesions with pattern IV were in the nonresponder group. Magnetic resonance imaging diameter of lesions with types I, II, and IV patterns showed significant correlation with the histological diameter. Among them, the correlation factor was highest in pattern IV (ρ = 0.94, P < 0.001) followed by pattern I (ρ = 0.67, P < 0.01) and pattern II (ρ = 0.502, P = 0.08). However, in type III shrinkage pattern, tumor size measured on MRI was not significantly correlated with histological size (P = 0.87). Types III and I shrinkage patterns were more frequently observed in the pathological responder group, and type IV was more frequently noted in the nonresponder group. Tumor diameter measured on MRI showed strong correlation with histological diameter in lesions with types I and IV shrinkage patterns, whereas lesions with type III did not show significant correlation. Type II pattern showed similar frequencies between the 2 groups and moderate correlation between sizes obtained from MRI and histology.
    Journal of computer assisted tomography 03/2012; 36(2):200-6. · 1.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
    Journal of breast cancer. 03/2012; 15(1):111-8.
  • Journal of Genetic Medicine. 01/2012; 9(1):25.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A granular cell tumor of breast is a rare and usually benign tumor originating from Schwann cells. The mammographic and sonographic appearances of a granular cell tumor pose a diagnostic dilemma because of its similarity to breast malignancy. We describe 2 cases of breast granular cell tumors in male patients, which were confirmed after surgical excision and histologic examination.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2011; 30(9):1295-301. · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE). Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed. We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded. Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD(axial)/LVD(axial) ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death. Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD(4-CH)/LVD(4-CH) ratio are predictive of adverse outcomes, whereas RVD(axial)/LVD(axial) ratio >1.0 is not.
    JACC. Cardiovascular imaging 08/2011; 4(8):841-9. · 14.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the incremental value of combined assessment with computed tomographic (CT) signs of right ventricular (RV) dysfunction and cardiac troponin T level for predicting early death or adverse outcomes due to acute pulmonary embolism (PE). One hundred seventy-three non-high-risk patients with acute PE, confirmed by CT pulmonary angiography, were retrospectively evaluated. The area under the curve and hazard ratio of CT signs and troponin T levels were compared for predicting early death or adverse outcomes. Patients were classified into intermediate- and low-risk groups on the basis of CT signs and troponin T levels, and mortality was compared. Seventeen patients (9.8%) died within 3 months. Early mortality of intermediate-risk patients (14% to 19%) was higher than that of low-risk patents (2% to 6%). A ratio of RV volume to left ventricular volume > 1.5 had the highest area under the curve (0.709) and hazard ratio (5.402) for predicting early death. The combination of CT signs and elevated troponin T level had an increased area under the curve and hazard ratio for predicting early death and adverse outcomes compared to those of CT signs or elevated troponin T level alone. In conclusion, the combined assessment of the ratio of RV volume to left ventricular volume and an elevated troponin T level provided incrementally more prognostic information in non-high-risk patients with acute PE compared to the single predictor of CT signs or troponin T level.
    The American journal of cardiology 07/2011; 108(1):133-40. · 3.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To use coronary computed tomographic (CT) angiography to compare the prevalence, extent, and composition of coronary atherosclerotic lesions in African American and white patients with acute chest pain. The institutional review board waived the requirement for informed consent for this retrospective, HIPAA-compliant matched-cohort study. The authors analyzed the CT angiographic data of 301 patients (150 consecutive African American patients; 151 white control patients; mean age, 55 years ± 11 [standard deviation]; 33% male) with acute chest pain. Each coronary artery segment was evaluated for presence of atherosclerotic plaque, plaque composition (calcified, noncalcified, or mixed), and stenosis. In addition, the noncalcified plaque volume was quantified by using a threshold-based automated algorithm. The presence and extent of atherosclerotic plaque were compared between the groups by using univariate and multivariate regression analyses. While there was no significant difference between the African American and white patients with respect to presence of any plaque (118 [79%] of 150 vs 112 [74%] of 151 patients, respectively; P = .36) or presence of stenosis (26 [17%] vs 37 [24%] patients, respectively; P = .13), the African American patients had a significantly higher prevalence (96 [64%] vs 62 [41%] patients, respectively; P < .001) and volume (median volume, 2.2 vs 1.4 mL, respectively; P < .001) of noncalcified plaque, independent of diabetes and other cardiovascular risk factors (odds ratio, 2.45; 95% confidence interval: 1.52, 4.04). In contrast, the African American patients had a lower prevalence of calcified plaque (39 [26%] vs 68 [45%] white patients, P = .001). Study results suggest that atherosclerotic plaque burden and composition, as measured by using coronary CT angiography, differ between African American and white patients, with relatively more noncalcified disease in African Americans and more calcified disease in white individuals. Further research is warranted to determine whether CT plaque characterization can improve cardiac risk prediction in African Americans.
    Radiology 06/2011; 260(2):373-80. · 6.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Myocardial perfusion is an important prognostic marker in the management of patients with suspected coronary artery disease as it demonstrates the hemodynamic consequences of coronary artery stenosis. The traditional diagnostic algorithm is based on a combination of physiological and anatomical testing using different modalities. Physiological testing, such as nuclear imaging, has been extensively validated for determining the effect of stenoses on the myocardial perfusion but provides only limited anatomical information. Conversely, anatomical testing, such as invasive coronary angiography, can directly visualize and grade coronary artery stenosis but has limitations for gauging their hemodynamic effect on the myocardial perfusion. Accordingly, a single test allowing the comprehensive evaluation of all aspects of coronary artery disease is clinically desirable. There is early evidence that cardiac computed tomography (CT) performed in single- or dual-energy mode has the potential for an integrative evaluation of both, coronary artery anatomy as well as changes in the myocardial blood supply. Cardiac dual-energy CT is based on the more recent technology of dual-source CT, and exploits the fact that iodine-based contrast medium has unique spectral characteristics when penetrated with different X-ray energy levels, enabling mapping of the iodine (and thus blood) distribution within the myocardium. This chapter provides an overview about the role and current state of dual-energy CT in the evaluation of the myocardial perfusion.
    01/2011: pages 111-124;