Kyoung Doo Song

Sungkyunkwan University, Seoul, Seoul, South Korea

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Publications (14)20.95 Total impact

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    ABSTRACT: OBJECTIVE. The purpose of this article is to evaluate the antiangiogenic effects of brivanib using dynamic contrast-enhanced MRI (DCE-MRI) in an orthotopic mouse model of human hepatocellular carcinoma (HCC). MATERIALS AND METHODS. With human HCC (HepG2 cell line) orthotopic nude mouse xenografts, brivanib was administered orally to the treatment group, and the vehicle was administered to the control group for 14 days. DCE-MRI was performed before the start of the therapy and 7 and 14 days after the start of therapy. Treatment-induced changes in tumor volume and microvessel density (MVD) assessed by CD31 immunohistochemistry were analyzed. Perfusion parameters, including volume transfer constant between blood plasma and extravascular extracellular space (K(trans)), fractional extravascular extracellular space per unit volume of tissue (ve), and rate constant between extravascular extracellular space and blood plasma (Kep), were calculated using the two-compartment model. RESULTS. Brivanib shows potent antitumor activity in tumor volume. The mean (± SD) MVD of the tumors was statistically significantly lower in the brivanib-treated group (40.8 ± 17.3 vessels/field) than in the control group (55.2 ± 9.05 vessels/field) (p < 0.05). In the control group, the K(trans) value increased statistically significantly between the baseline and 14 days after treatment (p = 0.048). In the brivanib-treated group, the K(trans) and ve values decreased statistically significantly between baseline and 7 days after treatment (p = 0.024 and p = 0.031, respectively) and between baseline and 14 days after treatment (p = 0.043 and p = 0.018, respectively). The difference between the K(trans) and ve values between baseline and 14 days after treatment showed a statistically significant difference between the two groups (p = 0.004 and p = 0.034, respectively). CONCLUSION. DCE-MRI is feasible in the orthotopic mouse model of human HCC, and it can noninvasively monitor brivanib-induced changes in tumor microvasculature.
    AJR. American journal of roentgenology. 06/2014; 202(6):W559-66.
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    ABSTRACT: To determine the value of fusion imaging with contrast-enhanced ultrasonography (CEUS) and computed tomography (CT)/magnetic resonance (MR) images for percutaneous radiofrequency ablation (RFA) of very-early-stage hepatocellular carcinomas (HCCs) that are inconspicuous on fusion imaging with B-mode ultrasound (US) and CT/MR images. This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. Fusion imaging with CEUS using Sonazoid contrast agent and CT/MR imaging was performed on HCCs (<2 cm) that were inconspicuous on fusion imaging with B-mode US. We evaluated the number of cases that became conspicuous on fusion imaging with CEUS. Percutaneous RFA was performed under the guidance of fusion imaging with CEUS. Technical success and major complication rates were assessed. In total, 30 patients with 30 HCCs (mean, 1.2 cm; range, 0.6-1.7 cm) were included, among which 25 (83.3%) became conspicuous on fusion imaging with CEUS at the time of the planning US and/or RFA procedure. Of those 25 HCCs, RFA was considered feasible for 23 (92.0%), which were thus treated. The technical success and major complication rates were 91.3% (21/23) and 4.3% (1/23), respectively. Fusion imaging with CEUS and CT/MR imaging is highly effective for percutaneous RFA of very-early-stage HCCs inconspicuous on fusion imaging with B-mode US and CT/MR imaging.
    Clinical and molecular hepatology. 03/2014; 20(1):61-70.
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    ABSTRACT: To evaluate the incidence and causes of mistargeting after fusion imaging-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinomas (HCCs). Between September 2011 and March 2013, 955 HCCs in 732 patients were treated with percutaneous RF ablation. Among them, ablation of 551 HCCs was accomplished under fusion imaging guidance, and seven mistargetings were noted in seven patients (male-to-female ratio = 6:1; mean age, 60.1 y; range, 47-73 y). The incidence of mistargeting and the cause of liver disease in the patients with mistargeting were evaluated. The causes of mistargeting were assessed according to the following classification: small size of HCC, subcapsular location, subphrenic location, confusion with pseudolesions, poor conspicuity of HCC, poor sonographic window, and poor electrode path. The incidence of mistargeting after fusion imaging-guided RF ablation was 1.3% (7 of 551). All patients with mistargeting were hepatitis B virus carriers. The most common cause of mistargeting was the small size of HCC (100%; 7 of 7), followed by confusion with surrounding pseudolesions (85.7%; 6 of 7), subcapsular (71.4%; 5 of 7) and subphrenic locations (71.4%; 5 of 7), poor conspicuity of the HCC (71.4%; 6 of 7), poor sonographic window (28.6%; 2 of 7), and poor electrode path (28.6%; 2 of 7). The incidence of mistargeting after fusion imaging-guided RF ablation was 1.3%. The most common cause of mistargeting was the small size of HCC, followed by confusion with surrounding pseudolesions, subcapsular and subphrenic locations, and poor conspicuity of the HCC.
    Journal of vascular and interventional radiology: JVIR 12/2013; · 1.81 Impact Factor
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    ABSTRACT: Hepatocyte specific contrast agents including gadoxetic acid and gadobenate dimeglumine are very useful to diagnose various benign and malignant focal hepatic lesions and even helpful to estimate hepatic functional reservoir. The far delayed phase image referred to as the hepatobiliary phase makes the sensitivity of detection for malignant focal hepatic lesions increased, but specificity of malignant diseases, including hepatocellular carcinoma, metastasis and cholangiocarcinoma, characterization remained to be undetermined.
    Clinical and molecular hepatology. 12/2013; 19(4):360-366.
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    ABSTRACT: OBJECTIVE. The objective of our study was to assess whether fusion imaging of conventional ultrasound and liver CT or MR images can improve the conspicuity of lesions and feasibility of percutaneous radiofrequency ablation (RFA) for the treatment of hepatocellular carcinomas (HCCs) not visible on ultrasound. Whether peritumoral anatomic landmarks can be used for the placement of an electrode in HCCs not visible on ultrasound even after image fusion was also evaluated. MATERIALS AND METHODS. Planning ultrasound for percutaneous RFA was performed using conventional ultrasound first and then using fusion imaging later during the same session. The visibility of HCCs and feasibility of RFA on conventional ultrasound and on fusion imaging were assessed. We evaluated how many HCCs initially not visible on conventional ultrasound could be visualized and ablated after applying the fusion imaging technique. One hundred twenty HCCs not visible on conventional ultrasound in 96 patients were included. RESULTS. When fusion imaging was applied, 38 of the 120 (31.7%) HCCs that were initially not visible could be seen and RFA was feasible. Among the remaining 82 HCCs still not visible after image fusion, 26 (31.7%) were ablated under the guidance of fusion imaging the technique based on peritumoral anatomic landmarks. Overall, 64 of 120 (53.3%) HCCs (59.4%, 57 of 96 patients) not visible on conventional ultrasound could be ablated under the guidance of the fusion imaging technique. CONCLUSION. Fusion imaging can improve the conspicuity of HCCs and the feasibility of percutaneous RFA of HCCs not visible on conventional ultrasound. Peritumoral anatomic landmarks can be used for electrode placement in HCCs that are still not visible even after image fusion.
    American Journal of Roentgenology 11/2013; 201(5):1141-7. · 2.90 Impact Factor
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    ABSTRACT: Angiogenesis inhibition is an attractive therapeutic strategy in the management of solid tumors. Vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) are key factors in growth and neovascularization of hepatocellular carcinoma (HCC). Brivanib is a novel, orally available dual tyrosine kinase inhibitor that selectively targets the key angiogenesis receptors VEGF‑R2, FGF‑R1 and FGF‑R2. Recently, high‑resolution magic angle spinning magnetic resonance spectroscopy (HR‑MAS MRS) has provided the opportunity to investigate more detailed metabolic profiles from intact tissue specimens that are correlated with histopathology and is thus, a promising tool for monitoring changes induced by treatment. In the present study, 1H HR‑MAS MRS and immunohistochemistry were used to investigate the antitumor efficacy of brivanib in HCC xenograft models. Tumor growth was significantly suppressed in brivanib‑treated mice compared with the controls and treatment was associated with the inhibition of angiogenesis, increased apoptosis and inhibition of cell proliferation. Furthermore, HR‑MAS techniques showed altered metabolic profiles between the two groups. HR‑MAS spectra demonstrated a significant decrease in choline metabolite levels in the treated groups, concurrent with decreased cell proliferation and increased apoptosis. The results showed that 1H HR‑MAS MRS provides quantitative metabolite information that may be used to analyze the efficacy of brivanib treatment in Hep3B tumor xenografts. Thus, the HR‑MAS MRS technique may be a complementary method to support histopathological results and increase its potential for use in the clinic.
    Molecular Medicine Reports 09/2013; · 1.17 Impact Factor
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    ABSTRACT: PURPOSE: To describe peritoneal manifestations of fascioliasis on CT. MATERIALS AND METHODS: We reviewed CT images in 31 patients with fascioliasis confirmed by enzyme-linked immunosorbent assay (ELISA) (n = 24) or surgery (n = 7). Image analyses were performed to identify hepatic, biliary, and peritoneal abnormalities. RESULTS: Hepatic abnormalities were seen in 28 (90.3 %) of the 31 patients. The most common finding was caves sign, which was present in 25 (80.1 %) patients. Three patients (9.7 %) presented with biliary abnormalities exhibiting dilatation and enhancing wall thickening of the bile duct, wall thickening of the gallbladder, and elongated structures in the bile duct or gallbladder. Peritoneal abnormalities were seen in 14 (45.2 %) of the 31 patients. The most common peritoneal abnormality was mesenteric or omental infiltration, which was seen in 9 (29.0 %) patients. Other peritoneal findings included lymph node enlargement (n = 7), ascites (n = 7), thickening of ligamentum teres (n = 2), and peritoneal mass (n = 2). CONCLUSION: Peritoneal manifestations of fascioliasis are relatively common, and CT findings include mesenteric or omental infiltration, lymph node enlargement, ascites, thickening of the ligamentum teres, and peritoneal masses.
    Abdominal Imaging 02/2013; · 1.91 Impact Factor
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    ABSTRACT: Key Words: Stomach neoplasm; Computed tomography; Peritoneum; Neoplasm metastasis; Ascites. Abbreviations: Advanced Gastric Cancer (AGC); Dry Peritoneal Seeding (DPS); Receiver Operating Characteristic (ROC); Computed Tomography (CT); Multi-Detector CT (MDCT); Area Under the ROC Curve (Az); Area Under the Receiver Operating Characteristic Curve (AUC); American Joint Committee on Cancer (AJCC). Background/Aims: To determine the significant CT findings of dry peritoneal seeding (DPS) in patients with advanced gastric cancer (AGC) and to assess whether radiologists' performance in the detection of DPS can be improved using these significant CT findings. Methodology: Two radiologists reviewed CT images of AGC patients with DPS and without seeding for the presence or absence of various CT findings suggesting peritoneal seeding, in consensus. Significant CT findings for DPS were determined using Fisher's exact test. Two other observers, blinded to the results of the consensus review during the first session but not during the second session, evaluated the presence or absence of DPS independently on a five-point scale. Each observer's performance was evaluated using a pair-wise comparison of the receiver operating characteristic (ROC) curves. Results: Soft tissue nodule or plaque on the peritoneal surface was the only significant CT finding of DPS (p=0.014). The areas under the ROC curves of the two observers were not significantly different between the two review sessions. Conclusions: Soft tissue nodule or plaque on the peritoneal surface was a significant CT finding for the detection of DPS. However, radiologists' performance for the detection of DPS did not improve despite knowledge of this finding.
    Hepato-gastroenterology 10/2012; 59(119):2202-6. · 0.77 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the accuracy of pre-operative MRI for the detection of optic nerve invasion in retinoblastoma. MATERIALS AND METHODS: Institutional review board approval and informed consent were waived for this retrospective study. A total of 41 patients were included. Inclusion criteria were histologically proven retinoblastoma, availability of diagnostic-quality preoperative MR images acquired during the 4 weeks before surgery, unilateral retinoblastoma, and normal-sized optic nerve. Two radiologists retrospectively reviewed the MR images independently. Five imaging findings (diffuse mild optic nerve enhancement, focal strong optic nerve enhancement, optic sheath enhancement, tumor location, and tumor size) were evaluated against optic nerve invasion of retinoblastoma. The predictive performance of all MR imaging findings for optic nerve invasion was also evaluated by the receiver operating characteristic curve analysis. RESULTS: Optic nerve invasion was histopathologically confirmed in 24% of study population (10/41). The differences in diffuse mild enhancement, focal strong enhancement, optic sheath enhancement, and tumor location between patients with optic nerve invasion and patients without optic nerve invasion were not significant. Tumor sizes were 16.1mm (SD: 2.2mm) and 14.9mm (SD: 3.6mm) in patients with and without optic nerve involvement, respectively (P=0.444). P-Values from binary logistic regression indicated that all five imaging findings were not significant predictors of tumor invasion of optic nerve. The AUC values of all MR imaging findings for the prediction of optic nerve invasion were 0.689 (95% confidence interval: 0.499-0.879) and 0.653 (95% confidence interval: 0.445-0.861) for observer 1 and observer 2, respectively. CONCLUSION: Findings of MRI in patients with normal-sized optic nerves have limited usefulness in preoperatively predicting the presence of optic nerve invasion in retinoblastoma.
    European journal of radiology 09/2012; · 2.65 Impact Factor
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    ABSTRACT: As diffusion-weighted imaging (DWI) is routinely incorporated into the standard clinical protocol, it is clinically relevant to determine whether DWI after gadoxetic acid is comparable to pre-contrast DWI, with regard to the detection and characterization of focal liver lesions. To compare DWI before and after administration of gadoxetic acid in the detection and characterization of small (≤2.5 cm) focal hepatic lesions. One hundred and fifty-eight patients with 237 focal hepatic lesions (≤2.5 cm) (124 HCCs, 50 metastases, 2 cholangiocarcinomas, 43 hemangiomas, and 18 cysts) were included. DWIs were obtained before and after administration of gadoxetic acid. Non-breath-hold DWI was performed with b values of 0, 100, and 800 s/mm(2). Signal-to-noise ratio (SNR), lesion-liver contrast-to-noise ratio (CNR), and apparent diffusion coefficients (ADCs) of the liver and lesion were calculated. Lesion detection with each DWI was evaluated with alternative free-response receiver-operating characteristic analysis by two observers. The sensitivity of the characterization of focal hepatic lesions as solid (malignancy) or non-solid (benignity) with each DWI was calculated using a five-point confidence scale. Inter-observer agreement regarding lesion detection and characterization was evaluated using kappa statistics. SNRs of the liver on post-contrast DWI were significantly lower than on unenhanced DWI at b = 800 s/mm(2) (P < 0.05). SNRs, CNRs, and ADCs of focal hepatic lesions were not significantly different between two DWIs (P > 0.05). The diagnostic accuracy (Az) for lesion detection and the sensitivity for lesion characterization did not show significant difference between two DWIs (P > 0.05). With regard to the detection and characterization of focal hepatic lesions, the kappa values for two DWIs indicated good and excellent inter-observer agreement, respectively. Gadoxetic acid-enhanced DWI showed comparable diagnostic capability to unenhanced DWI for the detection and characterization of small focal hepatic lesions.
    Acta Radiologica 04/2012; 53(5):485-93. · 1.33 Impact Factor
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    ABSTRACT: The objective of our study was to assess the utility of dual-energy CT for characterizing renal masses using iodine overlay techniques and virtual unenhanced images and to measure the potential radiation dose reduction for two-phase kidney CT compared with a standard three-phase protocol. Sixty patients with suspected renal masses underwent dual-energy CT including true unenhanced, dual-energy corticomedullary, and dual-energy late nephrographic phase imaging. Iodine overlay and virtual unenhanced images were derived from the corticomedullary and late nephrographic phases, respectively. The CT numbers of renal masses were calculated using the iodine overlay images superimposed on the virtual unenhanced images. The overall imaging quality of the true unenhanced images and of the virtual unenhanced images was also evaluated. The effective radiation doses for dual-energy CT and for true unenhanced imaging were calculated. For overlay or enhancement values on iodine overlay images, 36 simple cysts and 10 hemorrhagic cysts had an attenuation value of less than 20 HU, whereas 21 renal cell carcinomas showed an attenuation value of 20 HU or greater. Eleven angiomyolipomas contained macroscopic fat tissue. All renal masses were accurately classified on the basis of dual-energy CT. The imaging quality of the virtual unenhanced images from the corticomedullary and late nephrographic phases was inferior to the image quality of the true unenhanced images (p < 0.01). The mean effective doses for the three-phase protocol and for true unenhanced images were 12.6 and 2.4 mSv, respectively. Our results show that dual-energy CT using iodine overlay techniques and virtual unenhanced images may be useful for characterizing renal masses.
    American Journal of Roentgenology 12/2011; 197(6):W1076-82. · 2.90 Impact Factor
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    ABSTRACT: The objective of our study was to compare the indirect MR arthrographic findings of patients with adhesive capsulitis and patients without adhesive capsulitis. Indirect MR arthrograms of 35 patients (21 women, 14 men; mean age, 50.1 years) diagnosed with adhesive capsulitis clinically were compared with indirect MR arthrograms of 45 patients (23 women, 22 men; mean age, 48.9 years) without adhesive capsulitis. Joint capsule thickness in the axillary recess and the thicknesses of the enhancing portion of the axillary recess and the rotator interval were, respectively, evaluated on coronal T2-weighted images and coronal and sagittal fat-suppressed enhanced T1-weighted images by two radiologists independently. Reliability was studied using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were compared. Patients with adhesive capsulitis had significantly thickened joint capsules in the axillary recess and a thickened enhancing portion in the axillary recess and in the rotator interval. The difference in the thicknesses of the enhancing portion in the axillary recess and in the rotator interval were significantly greater than the difference in joint capsule thicknesses in the axillary recess between the adhesive capsulitis group and the control group (p < 0.001). Interobserver reliability was good for all three indexes (ICC ≥ 0.80). The area under the ROC curve for the thickness of the joint capsule in the axillary recess and the thicknesses of the enhancing portion of the axillary recess and the rotator interval were 0.797, 0.861, and 0.847, respectively. An abundance of enhancing tissue in the rotator interval and thickening and enhancement of the axillary recess are signs suggestive of adhesive capsulitis on indirect MR arthrography.
    American Journal of Roentgenology 12/2011; 197(6):W1105-9. · 2.90 Impact Factor
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    ABSTRACT: We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micronodules (MN, diameter < 4 mm) and significant nodules (SN, 4 ≤ diameter ≤ 10 mm). The radiologic reports and CAD results were compared. The CAD system helped detect 426 nodules; 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance.
    Korean journal of radiology: official journal of the Korean Radiological Society 03/2011; 12(2):163-8. · 1.32 Impact Factor
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    ABSTRACT: We aimed to review the patterns of lung abnormalities of pulmonary cryptococcosis on CT images, position emission tomography (PET) findings of the disease, and the response of lung abnormalities to the therapies in non-AIDS patients. We evaluated the initial CT (n = 23) and 18F-fluorodeoxyglucose (FDG) PET (n = 10), and follow-up (n = 23) imaging findings of pulmonary cryptococcosis in 23 non-AIDS patients. Lung lesions were classified into five patterns at CT: single nodular, multiple clustered nodular, multiple scattered nodular, mass-like, and bronchopneumonic patterns. The CT pattern analyses, PET findings, and therapeutic responses were recorded. A clustered nodular pattern was the most prevalent and was observed in 10 (43%) patients. This pattern was followed by solitary pulmonary nodular (n = 4, 17%), scattered nodular (n = 3, 13%), bronchopneumonic (n = 2, 9%), and single mass (n = 1, 4%) patterns. On PET scans, six (60%) of 10 patients showed higher FDG uptake and four (40%) demonstrated lower FDG uptake than the mediastinal blood pool. With specific treatment of the disease, a complete clearance of lung abnormalities was noted in 15 patients, whereas a partial response was noted in seven patients. In one patient where treatment was not performed, the disease showed progression. Pulmonary cryptococcosis most commonly appears as clustered nodules and is a slowly progressive and slowly resolving pulmonary infection. In two-thirds of patients, lung lesions show high FDG uptake, thus simulating a possible malignant condition.
    Korean journal of radiology: official journal of the Korean Radiological Society 01/2010; 11(4):407-16. · 1.32 Impact Factor