[Show abstract][Hide abstract] ABSTRACT: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion.
This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance.
Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively).
Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.
Korean journal of radiology: official journal of the Korean Radiological Society 07/2015; 16(4):835-45. DOI:10.3348/kjr.2015.16.4.835 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate the intraobserver reproducibility and to determine the elasticity characteristics of focal liver lesions (FLLs) by shear wave elastography (SWE).
One hundred thirty-six FLLs in 118 patients were examined with SWE for quantitative and qualitative assessment of stiffness. Three SWE images were obtained for each lesion and liver parenchyma by 1 radiologist. Intraobserver reproducibility was assessed by intraclass correlation coefficients (ICCs). Patient and lesion factors that can affect the reproducibility were evaluated. For characterization of the lesion elasticity, the difference in stiffness between the groups of lesions was evaluated.
The mean (SD) diameter and depth of the lesions were 3.98 (2.07) and 4.4 (1.59) cm, respectively. The ICC of intraobserver reproducibility was 0.763. Deep-seated lesions (≥6 cm; ICC, 0.621) showed significantly lower intraobserver reproducibility compared with superficial lesions (ICC, 0.793; P = 0.047). Stiffness values of malignant lesions (n = 85, 60.41 [47.81] kPa) were significantly higher than those of benign lesions (n = 51, 22.05 [17.24] kPa, P < 0.0001). Mean (SD) stiffness of hepatocellular carcinoma (45.72 [35.65] kPa) was significantly lower than that of metastasis (67.43 [43.39] kPa) and was significantly higher than benign FLLs (22.05 [17.24] kPa). However, mean (SD) lesion-parenchyma ratio of hepatocellular carcinoma (3.76 ) was not significantly different from that of benign FLLs (3.7 [3.77]).
Overall, intraobserver reproducibility of SWE in evaluation of FLLs was excellent, but it can be affected by lesion depth. In addition, SWE is helpful in elasticity characterization of FLLs.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the effect of 1 mm, 3 mm, and 5 mm section thicknesses of liver CT on the detection and grading of esophageal varices in cirrhotic patients.
A total of 219 consecutive cirrhotic patients who had undergone both upper endoscopy and 64-channel liver CT were included. Portal phase images of each CT were reconstructed with a section thickness of 1 mm, 3 mm, and 5 mm. Four radiologists independently reviewed the 3 image sets. The observers evaluated the presence of esophageal varices on a 5-point confidence scale and measured the maximal short diameter of the largest varix identified. Sensitivity, specificity and predictive value calculation and receiver operating characteristic analysis were performed. Correlation between CT measurements and endoscopic grading as the reference standard was assessed.
The averaged Az values at 1 mm, 3 mm, and 5 mm image sets were 0.936, 0.946, and 0.935, respectively, and they were not significantly different among the 4 observers. When a 3 mm cut-off criterion for large varices was applied, sensitivity, specificity, and predictive values were comparable among the 3 image datasets.
Routine liver CT protocol is sufficient for evaluation of esophageal varices in cirrhotic patients without adding thin section reconstruction images.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.
Forty-two patients were included in the study. On MRE, mean stiffness values were measured on the elastograms in kilopascals. The apparent diffusion coefficient (ADC) of the liver was measured using DWI. On gadoxetic acid enhanced MR, the contrast enhancement index (CEI) was calculated as signal intensity (SI)post/SIpre, where SIpost is liver-to-muscle SI ratio on hepatobiliary phase images and SIpre is that on nonenhanced images. Correlation between aspartate aminotransferase to the platelet ratio index (APRI) and three MR parameters was assessed. Each MR parameter was compared between a hepatic fibrosis (HF) group and non-hepatic fibrosis (nHF) group.
Liver stiffness showed strong positive correlation with APRI [Spearman correlation coeffiecient (r) = 0.773, P < 0.0001], while ADC and CEI showed weak or prominent negative correlation (r = -0.28 and -0.321, respectively). In the HF group, only liver stiffness showed strong correlation with APRI (r = 0.731, P < 0.0001). Liver stiffness, ADC, and APRI were significantly different between the HF group and nHF group.
MRE at 3-Tesla could be a feasible method for the assessment of hepatic fibrosis.
World Journal of Gastroenterology 12/2014; 20(46):17558-67. DOI:10.3748/wjg.v20.i46.17558 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intraperitoneal bleeding after radiofrequency ablation (RFA) is the most common major vascular complication due to direct needle injury to a vessel or liver capsule. However, intraperitoneal bleeding as a result of a delayed hepatic rupture after RFA for liver tumors is an extremely rare complication. The present report describes a case of intraperitoneal hemorrhage caused by delayed hepatic rupture resulting from arterioportal fistula after RFA for hepatic metastasis from colorectal cancer and successful management using transcatheter embolization.
Annals of Surgical Treatment and Research 07/2014; 87(1):41-3. DOI:10.4174/astr.2014.87.1.41
[Show abstract][Hide abstract] ABSTRACT: To evaluate effect of tumor size and contour type for the detection of renal cell carcinoma (RCC) on unenhanced CT.
This retrospective institutional review board approved study that includes 111 patients with RCC and 100 patients without RCC who underwent unenhanced CT. Two readers performed a blinded and independent review of the presence of RCC on unenhanced CT. The area under the receiver operating characteristic curves (AUC) was compared by tumor size (<3 cm: small, or ≥3 cm: large) and contour type (endophytic, mesophytic, or exophytic).
For tumor size, the AUC for small RCC (0.70 and 0.78, for reader 1 and reader 2) was significantly lower than that for large RCC (0.97 and 0.99, for reader 1 and reader 2) (p < 0.001). As for contour type of tumor, the AUC for endophytic RCC (0.60 and 0.71, for reader 1 and reader 2) was significantly lower than that for mesophytic RCC (0.95 and 0.98, for reader 1 and reader 2) and exophytic RCC (0.98 and 0.99, reader 1 and reader 2) (p < 0.001).
On unenhanced CT, tumor size and contour type can affect the detection of RCC. While most large or exophytic RCC can be easily detected, the detection of small and endophytic RCC is highly limited.
[Show abstract][Hide abstract] ABSTRACT: To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass.
This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset.
Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 ± 2.2 mGy) and DLP (641.2 ± 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 ± 2.7 mGy) and DLP (923.6 ± 158.8 mGy) of UE + ECT (p < 0.0001).
The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2014; 15(1):72-9. DOI:10.3348/kjr.2014.15.1.72 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: The aim of this study was to assess the enhancement patterns of hepatic focal nodular hyperplasia (FNH) on gadoxetic acid-enhanced MRI and diffusionweighted (DW) MRI. Methods: This retrospective study had institutional review board approval. Gadoxetic acid-enhanced and DW MR images were evaluated in 23 patients with 30 FNHs (26 histologically proven and 4 radiologically diagnosed). The lesion enhancement patterns of the hepatobiliary phase images were classified as heterogeneous or homogeneous signal intensity (SI), and as dominantly high/iso or low SI compared with those of adjacent liver parenchyma. Heterogeneous (any) SI lesions and homogeneous low SI lesions were categorised into the fibrosis group, whereas homogeneous high/iso SI lesionswere categorised into the non-fibrosis group. Additionally, lesion SI on T2 weighted images, DW images and apparent diffusion coefficient (ADC) values were compared between the two groups. Results: The lesions showed heterogeneous high/iso SI (n=16), heterogeneous low SI (n=5), homogeneous high/ iso SI (n=7) or homogeneous low SI (n=2) at the hepatobiliary phase MR images. The fibrosis group lesions were more likely to show high SI on DWimages and T2 weighted images compared with those in the non-fibrosis group (p<0.05). ADC values tended to be lower in the fibrosis group than those in the non-fibrosis group without significance. Conclusion: FNH showed variable enhancement patterns on hepatobiliary phase images during gadoxetic acidenhanced MRI. SI on DW and T2 weighted images differed according to the fibrosis component contained in the lesion.
The British journal of radiology 07/2013; 86(1028). DOI:10.1259/bjr.20130299 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ectopic prostatic tissue in the bladder has rarely been reported, and there is currently no report about the sonographic findings of this entity. In this study, we present the imaging findings of ectopic prostatic tissue in the bladder on transrectal ultrasonography.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of various strategies for revascularization of chronic total occlusion of femoropopliteal arteries when the guide wire does not pass in an anterograde direction.
Twenty-four patients with totally occluded femoropopliteal arteries (mean occlusion length 13.75 cm; range, 6-22 cm) were treated by using a retrograde approach and two novel catheters. After successful recanalization or reentry, balloon angioplasty followed by stent placement was performed to complete the revascularization.
In 16 cases in which to cross the occlusion via intraluminal or subintimal route was failed, we used Frontrunner catheters in five cases and Outback catheters in 11 cases. In eight cases in which to reenter after subintimal passage of the guide wire was failed, we used Outback catheters. Successful recanalization was achieved intraluminally or subintimally in all cases. One perforation occurred during subintimal passage of the guide wire that was controlled by recanalization of another subintimal tract. There were no cases of distal thromboembolism or other complications.
A retrograde approach and using the Frontrunner and Outback catheters are safe and effective for successful revascularization of chronic total occlusion of femoropopliteal arteries. In particular, they are useful when the initial antegrade attempts at recanalization have failed.
Korean journal of radiology: official journal of the Korean Radiological Society 07/2012; 13(4):467-75. DOI:10.3348/kjr.2012.13.4.467 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Benign regional lymph nodes (LNs) are sometimes enlarged in gastric cancer patients due to reactive or inflammatory changes. Frequently these enlarged LNs can mimic LN metastasis and lead to overstaging.
To assess frequency of benign regional LNs in gastric cancer patients compared with that in a healthy population and to assess the frequency of benign regional LNs in gastric cancer according to T-staging.
Between August 2005 and June 2009, 177 patients with surgically proven gastric cancer without LN metastasis (TanyN0M0) who had previously undergone preoperative multidetector row CT (MDCT) and 168 healthy patients who visited the healthcare center and underwent an abdominal MDCT were included in this retrospective study. An abdominal radiologist evaluated the distribution of regional LNs and measured the short diameter of LNs ≥6 mm, ≥8 mm, and ≥10 mm. The number of enlarged benign LNs was compared between the two groups, and the distribution of LN with regard to T-stage of gastric cancer was also evaluated.
At least one LN ≥6 mm, ≥8 mm, and ≥10 mm was detected in 64.4% (114/177), 22.0% (39/177), and 4.0% (7/177) of patients in the gastric cancer group, respectively, compared to 29.8% (50/168), 4.2% (7/168), and 0% of patients in the healthy group, respectively. The difference between the two groups was statistically significant (P <0.0001). The LN ≥8 mm was found in 14.9% (20/134) in early gastric cancer (T1), and 44.2% (19/43) in advanced cancer (T2 or higher); the difference was statistically significant (P = 0.0002). However, the frequency of LN ≥6 mm in mucosal cancer (T1a) and submucosal cancer (T2b) was not significantly different, regardless of its size.
Benign regional LNs ≥6 mm are more frequently detected in gastric cancer patients than in a healthy population and in advanced gastric cancer than in early cancer.
[Show abstract][Hide abstract] ABSTRACT: Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.
[Show abstract][Hide abstract] ABSTRACT: There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 02/2012; 59(2):65-84.
[Show abstract][Hide abstract] ABSTRACT: Left ventricular (LV) function is a vital parameter for prognosis, therapy guidance, and follow-up of cardiovascular disease. Dual-source computed tomography (DSCT) provides an accurate analysis of global LV function.
To assess the performance of DSCT in the determination of global LV functional parameters in comparison with cardiovascular magnetic resonance (CMR) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with valvular heart disease (VHD).
A total of 111 patients (58 men, mean age 49.9 years) with known VHD and who underwent DSCT, 2D-TTE, and CMR a period of 2 weeks before undergoing valve surgery were included in this study. LV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF) were calculated by DSCT using the threshold-based technique, by 2D-TTE using a modified Simpson's method, and by CMR using Simpson's method. Agreement for parameters of LV global function was determined with the Pearson's correlation coefficient (r) and Bland-Altman analysis. All the DSCT and CMR data-sets were assessed independently by two readers.
Fifty of the total 111 patients had aortic VHD, 29 patients had mitral VHD, and 32 patients had mixed aortic and mitral VHD. An excellent inter-observer agreement was seen for the assessment of global LV function using DSCT (r = 0.910-0.983) and CMR (r = 0.854-0.965). An excellent or good correlation (r = 0.93, 0.95, 0.87, and 0.71, respectively, P < 0.001) was noted between the DSCT and 2D-TTE values for EDV, ESV, SV, and EF. EDV (33.7 mL, P < 0.001), ESV (12.1 mL, P < 0.001), SV (21.2 mL, P < 0.001), and EF (1.6%, P = 0.019) were significantly overestimated by DSCT when compared with 2D-TTE. An excellent correlation (r = 0.96, 0.97, 0.91, and 0.94, respectively, P < 0.001) between DSCT and CMR was seen in the evaluation of EDV, ESV, SV, and EF. EDV (15.9 mL, P < 0.001), ESV (7.3 mL, P < 0.001), and SV (8.5 mL, P < 0.001) were significantly underestimated, but EF (1.1%, P = 0.002) was significantly overestimated by DSCT when compared with CMR.
Our study showed that DSCT measurements of global LV function using the threshold-based technique were highly reproducible and compared more favorably with CMR measurements using Simpson's method than those of 2D-TTE using the modified Simpson's method. DSCT enables accurate quantification of global LV function in patients with VHD.
[Show abstract][Hide abstract] ABSTRACT: The objective of the study was to retrospectively evaluate (a) which clinical/laboratory features are associated with the presence of diffuse gallbladder wall thickening (DGWT) in cirrhotic patients and (b) whether the degree of DGWT is correlated with such clinical/laboratory variables.
After excluding patients with DGWT or laboratory test abnormalities from known causes unrelated to liver cirrhosis, a retrospective review of liver computed tomography obtained from 242 consecutive cirrhotic patients was performed by 2 radiologists in consensus to determine the presence of DGWT of greater than 3 mm in thickness and, if present, to measure the degree of DGWT defined as maximal thickness. Univariate and multivariate analysis were performed to evaluate association between presence/degree of DGWT and clinical/laboratory features.
Of 242 patients, 73 (30.2%) had DGWT. Diffuse gallbladder wall thickening was seen in 7.6% (12/157) of patients with Child-Pugh class A, 61.1% (33/54) of class B, and 90.3% (28/31) of class C (P < 0.001). The presence of ascites, lower platelet count, and lower albumin level were independently associated with the presence of DGWT (P < 0.01, P = 0.01, and P = 0.02, respectively). However, these factors did not show significant correlation with the degree of DGWT.
The presence of DGWT in cirrhotic patients is associated with the presence of ascites, lower platelet count, and lower albumin level. The degree of DGWT is not correlated with such variables.