Publications by authors named "Hong Il Ha"

30 Publications

  • Page 1 of 1

Prediction of femoral osteoporosis using machine-learning analysis with radiomics features and abdomen-pelvic CT: A retrospective single center preliminary study.

PLoS One 2021 4;16(3):e0247330. Epub 2021 Mar 4.

Department of Statistics and Data Science Convergence Research Center, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.

Background: Osteoporosis has increased and developed into a serious public health concern worldwide. Despite the high prevalence, osteoporosis is silent before major fragility fracture and the osteoporosis screening rate is low. Abdomen-pelvic CT (APCT) is one of the most widely conducted medical tests. Artificial intelligence and radiomics analysis have recently been spotlighted. This is the first study to evaluate the prediction performance of femoral osteoporosis using machine-learning analysis with radiomics features and APCT.

Materials And Methods: 500 patients (M: F = 70:430; mean age, 66.5 ± 11.8yrs; range, 50-96 years) underwent both dual-energy X-ray absorptiometry and APCT within 1 month. The volume of interest of the left proximal femur was extracted and 41 radiomics features were calculated using 3D volume of interest analysis. Top 10 importance radiomic features were selected by the intraclass correlation coefficient and random forest feature selection. Study cohort was randomly divided into 70% of the samples as the training cohort and the remaining 30% of the sample as the validation cohort. Prediction performance of machine-learning analysis was calculated using diagnostic test and comparison of area under the curve (AUC) of receiver operating characteristic curve analysis was performed between training and validation cohorts.

Results: The osteoporosis prevalence of this study cohort was 20.8%. The prediction performance of the machine-learning analysis to diagnose osteoporosis in the training and validation cohorts were as follows; accuracy, 92.9% vs. 92.7%; sensitivity, 86.6% vs. 80.0%; specificity, 94.5% vs. 95.8%; positive predictive value, 78.4% vs. 82.8%; and negative predictive value, 96.7% vs. 95.0%. The AUC to predict osteoporosis in the training and validation cohorts were 95.9% [95% confidence interval (CI), 93.7%-98.1%] and 96.0% [95% CI, 93.2%-98.8%], respectively, without significant differences (P = 0.962).

Conclusion: Prediction performance of femoral osteoporosis using machine-learning analysis with radiomics features and APCT showed high validity with more than 93% accuracy, specificity, and negative predictive value.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247330PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932154PMC
March 2021

Reliability of 3D image analysis and influence of contrast medium administration on measurement of Hounsfield unit values of the proximal femur.

PLoS One 2020 21;15(10):e0241012. Epub 2020 Oct 21.

Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.

Purpose: To evaluate the reliability of 3D image analysis and the effect of an iodine contrast agent on the computed tomography (CT) Hounsfield unit (HU) values of the proximal femur.

Materials And Methods: Fifty female patients (mean age, 61.3 years; age range, 50-79 years) who underwent both pre- and post-enhancement abdominopelvic CT scans were included in this retrospective study. Whole 3D volumes of the left proximal femur from the head to the lesser trochanter were extracted using the regional growth technique with commercial 3D software. Total volume, mean HU, and HU histogram analysis (HUHA) values of the extracted femur were calculated. HUHA distribution was classified into HUHAfat for the assumed fatty marrow (percentage of negative HU values) and HUHAdense-bone (percentage of HU values ≥ 126 HU). Reliability was assessed by calculating intra- and interobserver correlation coefficients (ICCs) and by drawing Bland-Altman plots. The effect of contrast medium administration was evaluated by the paired t-test.

Results: All intra- and interobserver ICCs of 3D volume measurements showed excellent reproducibility (all ICCs > 0.90). On Bland-Altman analysis of two observers' 3D volume measurements, the differences in the mean total volume, HUHAfat, HUHAdense-bone, and mean HU were 2.4 cm3, 0.17%, 0.6%, and 1.9 HU, respectively. The mean difference in HU after contrast agent administration (-2.2 HU) was not significant (P = 0.27). The mean difference in HUHAfat and HUHAdense-bone after contrast agent administration were -1.1% and -2.2%, respectively, on the Bland-Altman plot. HUHAfat and HUHAdense-bone showed significant differences (P < 0.05). The 95% limits of agreement for HUHAfat, HUHAdense-bone, and mean HU were -3.6% to 1.3%, -6.5% to 2.1%, and -30.0 to 25.5 HU, respectively.

Conclusion: Image analysis based on 3D volume measurement of the proximal femur showed excellent reliability, with the contrast agent administration showing negligible influence on the mean HU.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241012PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577441PMC
December 2020

Computed Tomography Findings Associated with Treatment Failure after Antibiotic Therapy for Acute Appendicitis.

Korean J Radiol 2021 01 11;22(1):63-71. Epub 2020 Aug 11.

Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

Objective: To identify the CT findings associated with treatment failure after antibiotic therapy for acute appendicitis.

Materials And Methods: Altogether, 198 patients who received antibiotic therapy for appendicitis were identified by searching the hospital's surgery database. Selection criteria for antibiotic therapy were uncomplicated appendicitis with an appendiceal diameter equal to or less than 11 mm. The 86 patients included in the study were divided into a treatment success group and a treatment failure group. Treatment failure was defined as a resistance to antibiotic therapy or recurrent appendicitis during a 1-year follow-up period. Two radiologists independently evaluated the following CT findings: appendix-location, involved extent, maximal diameter, thickness, wall enhancement, focal wall defect, periappendiceal fat infiltration, and so on. For the quantitative analysis, two readers independently measured the CT values at the least attenuated wall of the appendix by drawing a round region of interest on the enhanced CT (HU) and non-enhanced CT (HU). The degree of appendiceal wall enhancement (HU) was calculated as the subtracted value between HU and HU. A logistic regression analysis was used to identify the CT findings associated with treatment failure.

Results: Sixty-four of 86 (74.4%) patients were successfully treated with antibiotic therapy, with treatment failure occurring in the remaining 22 (25.5%). The treatment failure group showed a higher frequency of hypoenhancement of the appendiceal wall than the success group (31.8% vs. 7.8%; = 0.005). Upon quantitative analysis, both HU (46.7 ± 21.3 HU vs. 58.9 ± 22.0 HU; = 0.027) and HU (26.9 ± 17.3 HU vs. 35.4 ± 16.6 HU; = 0.042) values were significantly lower in the treatment failure group than in the success group.

Conclusion: Hypoenhancement of the appendiceal wall was significantly associated with treatment failure after antibiotic therapy for acute appendicitis.
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http://dx.doi.org/10.3348/kjr.2019.0823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772384PMC
January 2021

Impact of respiratory motion on liver stiffness measurements according to different shear wave elastography techniques and region of interest methods: a phantom study.

Ultrasonography 2021 Jan 12;40(1):103-114. Epub 2020 Apr 12.

Department of Radiology, Seoul National University Hospital, Seoul, Korea.

Purpose: This study quantified the impact of respiratory motion on liver stiffness measurements according to different shear wave elastography (SWE) techniques and region of interest (ROI) methods, using liver fibrosis phantoms.

Methods: Three operators measured stiffness values in four phantoms with different stiffness on a moving platform with two SWE techniques (point-SWE [pSWE] and 2-dimensional SWE [2D-SWE]), three types of motion (static mode and moving mode at low and high speeds), and four ROI methods in 2D-SWE (circle, point, box, and multiple). The circular ROI method was used to compare the two SWE techniques. The occurrence of technical failure and unreliable measurements, stiffness values, and measurement time were evaluated.

Results: Technical failure was observed only in moving mode for pSWE and 2D-SWE (n=1 for both). Unreliable measurements were also only observed in moving mode and were significantly less common in 2D-SWE (n=1) than in pSWE (n=12) (P<0.001). No statistically significant differences in the technical failure rate or stiffness values were noted between the static and moving modes for both SWE techniques. The technical failure and unreliable measurement rates were not significantly different among the ROI methods for 2D-SWE. Stiffness values did not differ significantly according to the ROI method used in any moving mode. However, the multiple ROI method had significantly shorter measurement times than the circular ROI method for all moving modes.

Conclusion: 2D-SWE may be preferable for evaluating liver fibrosis in patients with poor breath-hold. Furthermore, 2D-SWE with multiple ROIs enables rapid measurements, without affecting liver stiffness values.
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http://dx.doi.org/10.14366/usg.19079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758106PMC
January 2021

Comparison of point and 2-dimensional shear wave elastography for the evaluation of liver fibrosis.

Ultrasonography 2020 Jul 6;39(3):288-297. Epub 2020 Mar 6.

Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, Korea.

Purpose: This study aimed to assess the technical performance of ElastQ Imaging compared with ElastPQ and to investigate the correlation between liver stiffness (LS) values obtained using these two techniques.

Methods: This retrospective study included 249 patients who underwent LS measurements using both ElastPQ and ElastQ Imaging equipped on the same machine. The applicability, repeatability (coefficient of variation [CV]), acquisition time, and LS values were compared using the chi-square or Wilcoxon signed-rank tests. In the development group, the correlation between the LS values obtained by the two techniques was assessed with Spearman correlation coefficients and linear regression analysis. In the validation group, the agreement between the estimated and real LS values was evaluated using a Bland-Altman plot.

Results: ElastQ Imaging had higher applicability (94.0% vs. 78.3%, P<0.001) and higher repeatability, with a lower median CV (0.127 vs. 0.164, P<0.001) than did ElastPQ. The median acquisition time of ElastQ Imaging was significantly shorter than that of ElastPQ (45.5 seconds vs. 96.5 seconds, P<0.001). The median LS value obtained using ElastQ Imaging was significantly higher than that obtained using ElastPQ (5.60 kPa vs. 5.23 kPa, P<0.001). The LS values between the two techniques exhibited a strong positive correlation (r=0.851, P<0.001) in the development group. The mean difference and 95% limits of agreement were 0.0 kPa (-3.9 to 3.9 kPa) in the validation group.

Conclusion: ElastQ Imaging may be more reliable and faster than ElastPQ, with strongly correlated LS measurements.
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http://dx.doi.org/10.14366/usg.19090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315295PMC
July 2020

Measurement of Pancreatic Fat Fraction by CT Histogram Analysis to Predict Pancreatic Fistula after Pancreaticoduodenectomy.

Korean J Radiol 2019 Apr;20(4):599-608

Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.

Objective: To evaluate the effectiveness of computed tomography (CT) Hounsfield unit histogram analysis (HUHA) in postoperative pancreatic fistula (PF) prediction.

Materials And Methods: Fifty-four patients (33 males and 21 females; mean age, 65.6 years; age range, 37-89 years) who had undergone preoperative CT and pancreaticoduodenectomy were included in this retrospective study. Two radiologists measured mean CT Hounsfield unit (CTHU) values by drawing regions of interest (ROIs) at the level of the pancreaticojejunostomy site on preoperative pre-contrast images. The HUHA values were arbitrarily divided into three categories, comprising HUHA-A ≤ 0 HU, 0 HU < HUHA-B < 30 HU, and HUHA-C ≥ 30 HU. Each HUHA value within the ROI was calculated as a percentage of the entire area using commercial 3-dimensional analysis software. Pancreas texture was evaluated as soft or hard by manual palpation.

Results: Fifteen patients (27.8%) had clinically relevant PFs. The PF group had significantly higher HUHA-A ( < 0.01) and significantly lower mean CTHU ( < 0.01) values than those of the non-PF group. The HUHA-A value had a moderately strong correlation with PF occurrence ( = 0.60, < 0.01), whereas the mean CTHU had a weak negative correlation with PF occurrence ( = -0.27, < 0.01). The HUHA-A and mean CTHU areas under the curve (AUCs) for predicting PF occurrence were 0.86 and 0.65, respectively, with significant difference ( < 0.01). The HUHA-A and mean CTHU AUCs for predicting pancreatic softness were 0.86 and 0.64, respectively, with significant difference ( < 0.01).

Conclusion: The HUHA-A values on preoperative pre-contrast CT images demonstrate a strong correlation with PF occurrence.
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http://dx.doi.org/10.3348/kjr.2018.0557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424834PMC
April 2019

High-pitch, 120 kVp/30 mAs, low-dose dual-source chest CT with iterative reconstruction: Prospective evaluation of radiation dose reduction and image quality compared with those of standard-pitch low-dose chest CT in healthy adult volunteers.

PLoS One 2019 24;14(1):e0211097. Epub 2019 Jan 24.

Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea.

Purpose: Objective of this study was to evaluate the effectiveness of the iterative reconstruction of high-pitch dual-source chest CT (IR-HP-CT) scanned with low radiation exposure compared with low dose chest CT (LDCT).

Materials And Methods: This study was approved by the institutional review board. Thirty healthy adult volunteers (mean age 44 years) were enrolled in this study. All volunteers underwent both IR-HP-CT and LDCT. IR-HP-CT was scanned with 120 kVp tube voltage, 30 mAs tube current and pitch 3.2 and reconstructed with sinogram affirmed iterative reconstruction. LDCT was scanned with 120 kVp tube voltage, 40 mAs tube current and pitch 0.8 and reconstructed with B50 filtered back projection. Image noise, and signal to noise ratio (SNR) of the infraspinatus muscle, subcutaneous fat and lung parenchyma were calculated. Cardiac motion artifact, overall image quality and artifacts was rated by two blinded readers using 4-point scale. The dose-length product (DLP) (mGy∙cm) were obtained from each CT dosimetry table. Scan length was calculated from the DLP results. The DLP parameter was a metric of radiation output, not of patient dose. Size-specific dose estimation (SSDE, mGy) was calculated using the sum of the anteroposterior and lateral dimensions and effective radiation dose (ED, mSv) were calculated using CT dosimetry index.

Results: Approximately, mean 40% of SSDE (2.1 ± 0.2 mGy vs. 3.5 ± 0.3 mGy) and 34% of ED (1.0 ± 0.1 mSv vs. 1.5 ± 0.1 mSv) was reduced in IR-HP-CT compared to LDCT (P < 0.0001). Image noise was reduced in the IR-HP-CT (16.8 ± 2.8 vs. 19.8 ± 3.4, P = 0.0001). SNR of lung and aorta of IR-HP-CT showed better results compared with that of LDCT (22.2 ± 5.9 vs. 33.0 ± 7.8, 1.9 ± 0.4 vs 1.1 ± 0.3, P < 0.0001). The score of cardiac pulsation artifacts were significantly reduced on IR-HP-CT (3.8 ± 0.4, 95% confidence interval, 3.7‒4.0) compared with LDCT (1.6 ± 0.6, 95% confidence interval, 1.3‒1.8) (P < 0.0001). SNR of muscle and fat, beam hardening artifact and overall subjective image quality of the mediastinum, lung and chest wall were comparable on both scans (P ≥ 0.05).

Conclusion: IR-HP-CT with 120 kVp and 30 mAs tube setting in addition to an iterative reconstruction reduced cardiac motion artifact and radiation exposure while representing similar image quality compared with LDCT.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211097PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345490PMC
October 2019

Comparison of the diagnostic performance of CT Hounsfield unit histogram analysis and dual-energy X-ray absorptiometry in predicting osteoporosis of the femur.

Eur Radiol 2019 Apr 25;29(4):1831-1840. Epub 2018 Sep 25.

Department of Radiology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Republic of Korea, 14068.

Purpose: To evaluate the diagnostic performance of Hounsfield unit histogram analysis (HUHA) of precontrast abdominal-pelvic CT scans for predicting osteoporosis.

Materials And Methods: The study included 271 patients who had undergone dual X-ray absorptiometry (DXA) and abdominal-pelvic CT within 1 month. HUHA was measured using commercial 3D analysis software (Aquarius iNtuition v4.4.12, TeraRecon) and expressed as a percentage of seven HU range categories related to the ROI: A < 0, 0 ≤ B < 25, 25 ≤ C < 50, 50 ≤ D < 75, 75 ≤ E < 100, 100 ≤ F < 130, and 130 ≤ G. A coronal reformatted precontrast CT image containing the largest Ward's triangle was selected and then the ROI was drawn over the femoral neck. Correlation (r) and ROC curve analyses were used to assess diagnostic performance in predicting osteoporosis using the femur T-score as the reference standard.

Results: When the femur T-score was used as the reference, the rs of HUHA-A and HUHA-G were 0.74 and -0.57, respectively. Other HUHA values had moderate to weak correlations (r = -0.33 to 0.27). The correlation of HUHA-A was significantly higher than that of HUHA-G (p = 0.03). The area under the curve (0.95) of HUHA-A differed significantly from that of HUHA-G (0.90; p < 0.01). A HUHA-A threshold ≥ 27.7% was shown to predict osteoporosis based on a sensitivity and specificity of 95.6% and 81.7%, respectively.

Conclusion: The HUHA-A value of the femoral neck is closely related to osteoporosis and may help predict osteoporosis.

Key Points: • HUHA correlated strongly with the DXA femur T-score (HUHA-A, r = 0.74). • The diagnostic performance of HUHA for predicting osteoporosis (AUC = 0.95) was better than that of the average CT HU value (AUC = 0.91; p < 0.05). • HUHA may help predict osteoporosis and enable semi-quantitative measurement of changes in bone mineral density.
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http://dx.doi.org/10.1007/s00330-018-5728-0DOI Listing
April 2019

Multicenter Phase II Study of Oxaliplatin, Irinotecan, and S-1 as First-line Treatment for Patients with Recurrent or Metastatic Biliary Tract Cancer.

Cancer Res Treat 2018 Oct 8;50(4):1324-1330. Epub 2018 Jan 8.

Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Purpose: Although gemcitabine plus cisplatin has been established as the standard first-line chemotherapy for patients with advanced biliary tract cancer (BTC), overall prognosis remains poor. We investigated the efficacy of a novel triplet combination of oxaliplatin, irinotecan, and S-1 (OIS) for advanced BTC.

Materials And Methods: Chemotherapy-naive patientswith histologically documented unresectable or metastatic BTC were eligible for this multicenter, single-arm phase II study. Patients received 65 mg/m2 oxaliplatin (day 1), 135 mg/m2 irinotecan (day 1), and 40 mg/m2 S-1 (twice a day, days 1-7) every 2 weeks. Primary endpoint was objective response rate. Targeted exome sequencing for biomarker analysis was performed using archival tissue.

Results: In total, 32 patients were enrolled between October 2015 and June 2016. Median age was 64 years (range, 40 to 76 years), with 24 (75%) male patients; 97% patients had metastatic or recurrent disease. Response rate was 50%, and median progression-free survival and overall survival (OS) were 6.8 months (95% confidence interval [CI], 4.8 to 8.8) and 12.5 months (95% CI, 7.0 to 18.0), respectively. The most common grade 3-4 adverse events were neutropenia (32%), diarrhea (6%), and peripheral neuropathy (6%). TP53 and KRAS mutations were the most frequent genomic alterations (42% and 32%, respectively), and KRAS mutations showed a marginal relationship with worse OS (p=0.07).

Conclusion: OIS combination chemotherapy was feasible and associated with favorable efficacy outcomes as a first-line treatment in patients with advanced BTC. Randomized studies are needed to compare OIS with gemcitabine plus cisplatin.
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http://dx.doi.org/10.4143/crt.2017.526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192931PMC
October 2018

Ultrasound features of secondary appendicitis in pediatric patients.

Ultrasonography 2018 Jul 25;37(3):233-243. Epub 2017 Aug 25.

Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.

Purpose: The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis.

Methods: In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test.

Results: Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P<0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P<0.001) or an appendicolith (34% vs. 11%, P<0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887).

Conclusion: The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.
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http://dx.doi.org/10.14366/usg.17029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044217PMC
July 2018

Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer?

Scand J Gastroenterol 2017 Oct 22;52(10):1057-1064. Epub 2017 Jun 22.

c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea.

Objectives: With the aging population, the number of elderly patients diagnosed with gastric cancer is increasing. However, determining treatment strategies for elderly patients with gastric cancer is controversial. The aim of this study is to evaluate the usefulness of surgical treatment on elderly patients aged ≥80 years with advanced gastric cancer.

Methods: A total of 147 elderly patients who were diagnosed with advanced gastric cancer from August 2001 to December 2015 were retrospectively analyzed. We compared the clinicopathological features and prognoses of 94 elderly patients (80-85 years) and 53 extreme-elderly patients (≥86 years) according to treatment modalities.

Results: In the elderly group, the 3-year overall survival (OS) rates of the surgical resection group and supportive care group were 42.1% and 4.0%, respectively (p < .001). In the extreme-elderly group, the 3-year OS rates of the surgical resection group and supportive care group were 36.4% and 8.0%, respectively (p = .028). The post-operative mortality rate of the elderly group and extreme-elderly group was 5.6% and 9.1%, respectively. In the analysis of risk factors associated with survival, surgical resection was a significantly good prognostic factor in the elderly group (hazard ratio [HR] = 0.277; p = .003) compared with supportive care. In the extreme-elderly group, surgical resection was associated with good prognosis but did not reach statistical significance (HR = 0.491; p = .099).

Conclusions: These results suggest that elderly patients aged 80-85 years with advanced gastric cancer could expect a better prognosis with surgical resection. However, extreme-elderly patients aged ≥86 years should consider the risks and benefits of surgical treatment.
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http://dx.doi.org/10.1080/00365521.2017.1339828DOI Listing
October 2017

A dose-finding study for oxaliplatin, irinotecan, and S-1 (OIS) in patients with metastatic or recurrent gastrointestinal cancer.

Cancer Chemother Pharmacol 2016 Nov 15;78(5):949-958. Epub 2016 Sep 15.

Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si, Gyeongigi-do, 14068, Republic of Korea.

Purposes: To determine the maximum tolerated dose (MTD), recommended dose (RD), and activity of combined oxaliplatin, irinotecan, and S-1 chemotherapy for metastatic or recurrent gastrointestinal (GI) cancer.

Methods: Oxaliplatin and irinotecan were administered intravenously on day 1, and S-1 was administered orally on days 1-7, every 2 weeks. This phase I study used the following dose levels for oxaliplatin/irinotecan/S-1: level 1, 85/120/60 mg/m; level 2, 85/120/80 mg/m; level 3, 85/120/100 mg/m; level 4, 85/150/100 mg/m; and level 5, 85/180/100 mg/m. Treatment was repeated for a maximum of 12 cycles, until disease progression, or until unacceptable toxicity.

Results: Twenty-four patients were enrolled between October 2012 and February 2014 (median age 59 years). During the first cycle, one of the six patients in levels 1, 3, and 4 developed a dose-limiting toxicity (grade 3 febrile neutropenia), and none of the three patients in level 5 developed a dose-limiting toxicity. As the planned maximum dose did not reach the MTD, the level 5 dose was defined as the RD. Twenty-one patients were evaluated for response, which included 2 cases of complete response and 8 cases of partial response, with an overall response rate of 47.6 %.

Conclusions: The combination of oxaliplatin, irinotecan, and S-1 provided an acceptable toxicity profile and modest clinical benefits in patients with advanced GI cancer. The RD was 85 mg/m of oxaliplatin, 180 mg/m of irinotecan, and 100 mg/m of S-1 every 2 weeks.
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http://dx.doi.org/10.1007/s00280-016-3147-yDOI Listing
November 2016

Invasion Depth Measured in Millimeters is a Predictor of Survival in Patients with Distal Bile Duct Cancer: Decision Tree Approach.

World J Surg 2017 Jan;41(1):232-240

Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea.

Background: AJCC staging system is unreliable for predicting survival in distal bile duct (DBD) cancer patients, due to inter-observer variation. Measured depth of invasion (DOI) is suggested to be more accurate to predict patients' clinical outcome in extra-hepatic cholangiocarcinomas, but its significance in DBD cancer and cutoff values are still debatable. This study aimed to identify the optimal cutoff value of DOI in relation to prognosis in DBD cancer patients.

Methods: Data of 179 patients with DBD adenocarcinoma treated in three institutions were investigated. Under microscopic review, DOI was measured. The relationships between the clinicopathological parameters and the groups based on DOI (≤3; 3-10; >10 mm) were evaluated, and the survival times of each group based on DOI and T classification were compared.

Results: Deeply invading tumors exhibited a greater tendency toward the infiltrative type, high histological grade, AJCC stage, and pancreatic, duodenal, lymphovascular and perineural invasion. The measured DOI was significantly correlated with worse relapse-free and overall survival (all p < 0.05). In multivariate analyses, the DOI remained as one of the prognostic factors (all p < 0.05), while T classification was not a significant prognostic factor. The new prognostic models (low, intermediate, and high risk) that applied DOI and nodal metastasis showed significant difference in recurrence and survival rate (all p < 0.05).

Conclusions: On the basis of the proposed cutoff value, the DOI could be clear and meaningful, overcoming the vagueness of the T classification for predicting clinical outcomes in patients with DBD carcinoma.
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http://dx.doi.org/10.1007/s00268-016-3687-7DOI Listing
January 2017

A Case of Spontaneous Isolated Dissection of Left Gastric Artery.

J Korean Med Sci 2016 Sep;31(9):1349-50

Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Anyang, Korea.

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http://dx.doi.org/10.3346/jkms.2016.31.9.1349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974173PMC
September 2016

Second-Line Irinotecan, Leucovorin, and 5-Fluorouracil for Gastric Cancer Patients after Failed Docetaxel and S-1.

Gastroenterol Res Pract 2016 29;2016:6857625. Epub 2015 Dec 29.

Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si, Gyeonggi-do 14068, Republic of Korea.

Background. This retrospective study aimed to assess the efficacy and toxicities of second-line chemotherapy with irinotecan, leucovorin, and 5-fluorouracil (5-FU) in metastatic gastric cancer (MGC) patients previously treated with docetaxel and S-1 with or without oxaliplatin (DS/DOS). Patients and Methods. We reviewed the data of patients who had previously been treated with first-line DS/DOS and received biweekly irinotecan-based chemotherapy (FOLFIRI/IFL) between October 2004 and November 2011. Results. A total of 209 cycles were administered to 35 patients, with a median of 4 (range, 1-22) cycles each. The overall response rate in 29 response-assessable patients was 17.2%, including 2 complete and 3 partial responses. The median progression-free and overall survivals were 3.81 (95% confidence interval [CI], 1.82-5.80) months and 6.24 (95% CI, 1.44-11.04) months, respectively. The major grade 3/4 toxicity was neutropenia (8.6%). Conclusion. FOLFIRI/IFL chemotherapy showed modest antitumour activity and tolerable toxicities in DS/DOS-treated MGC patients.
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http://dx.doi.org/10.1155/2016/6857625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709667PMC
February 2016

Replaced common hepatic artery from the superior mesenteric artery: multidetector computed tomography (MDCT) classification focused on pancreatic penetration and the course of travel.

Surg Radiol Anat 2016 Aug 12;38(6):655-62. Epub 2016 Jan 12.

Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.

Purpose: We categorize the subtypes of the replaced common hepatic artery (RCHA) and evaluate the clinical implications.

Methods: Thirty-four cases of the RCHA were evaluated retrospectively using multidetector computed tomography. We categorized them into the three RCHA subtypes according to pancreatic penetration and the passing routes. The distance between the orifice of the superior mesenteric artery (SMA) and RCHA bifurcation (D SMA-RCHA) was measured using advanced 3D imaging software. Analysis of variance was used to evaluate the difference in D SMA-RCHA according to the RCHA subtype.

Results: Type A (n = 17, 50 %) referred to RCHA penetrating the pancreatic parenchyma, all crossing the dorsal aspect of the superior mesenteric vein (SMV). Among them, three cases were accompanied by the circumportal pancreas. Type B (n = 10, 29 %) referred to RCHA without penetration of the pancreatic parenchyma and crossing of the dorsal aspect of the main portal vein (MPV) or SMV. Type C (n = 7, 21 %) referred to RCHA without penetration of the pancreas parenchyma and crossing of the ventral aspect of the MPV or SMV. The mean D SMA-RCHA of each subtype was as follows: type A, 3.13 cm [95 % confidence interval (CI) 2.70-3.57]; type B, 2.04 cm [95 % CI 1.40-2.68]; and type C, 2.14 cm [95 % CI 2.23-2.92]. The D SMA-RCHA of the penetrating pancreatic parenchyma of the RCHA was significantly longer than that of the non-penetrating pancreatic parenchyma (P = 0.007).

Conclusion: Half of RCHA show penetrating the pancreatic parenchyma, which was categorized as type A, and this type A takes off from the SMA more distally than RCHA without intrapancreatic penetration.
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http://dx.doi.org/10.1007/s00276-016-1618-9DOI Listing
August 2016

Intramural esophageal dissection diagnosed on transabdominal ultrasonography.

Jpn J Radiol 2015 Dec 22;33(12):764-8. Epub 2015 Oct 22.

Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.

Intramural esophageal dissection (IED) is an uncommon yet important clinical entity characterized by a rupture or fissure in the esophageal submucosal layer. IED could occur spontaneously or secondary to direct extrinsic injury to the esophageal mucosa. Traditionally, IED has been diagnosed on the swallowing study using water-soluble contrast agents or barium. For alternative diagnostic modalities, upper gastrointestinal endoscopy and chest computed tomography have been frequently performed. However, to the best of our knowledge, the transabdominal ultrasonography (USG) appearance of IED has not been reported in the literature yet. We report an interesting case of IED, which was initially diagnosed on the transabdominal USG.
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http://dx.doi.org/10.1007/s11604-015-0488-0DOI Listing
December 2015

Phase II study of gemcitabine and S-1 combination chemotherapy in patients with metastatic biliary tract cancer.

Cancer Chemother Pharmacol 2015 Apr 29;75(4):711-8. Epub 2015 Jan 29.

Department of Internal Medicine, Division of Hematology-Oncology, Hallym University Medical Center, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil Dongan-gu, Anyang-Si, 431-796, South Korea.

Purpose: A phase II study was conducted to evaluate the efficacy and safety of gemcitabine and S-1 combination chemotherapy in patients with metastatic biliary tract cancer (BTC).

Methods: Patients with pathologically confirmed, unresectable, recurrent, or metastatic adenocarcinoma that originated from the intrahepatic or extrahepatic biliary ducts or gallbladder were assessed for eligibility. The primary end point was the overall response rate (ORR). The treatment consisted of 1,000 mg/m(2) intravenous gemcitabine administered over 30 min on days 1 and 8, and 80 mg/m(2) oral S-1 on days 1-14 of each cycle. The treatment was repeated every 3 weeks.

Results: Thirty-eight patients were enrolled between November 2005 and 2010. All patients had metastatic disease, and the primary sites of cancer were as follows: gallbladder in 12 (31.6%), intrahepatic and extrahepatic bile ducts in 23 (60.5%), and the ampulla of Vater in 3 (7.9%) patients. One patient achieved a complete response, and six experienced a partial response. The ORR was 20.6% (95% CI 8.5-36.7] in the per-protocol (PP) population, and 18.4% (95%CI 6.1-30.7) in the intention-to-treat (ITT) population; the median response duration was 10.8 months. Nineteen patients had stable disease, and the disease control rate was 76.5% (95%CI 60.6-87.6) in the PP population. The median progression-free survival was 4.4 months (95%CI 1.8-6.9), and the median overall survival was 9.0 months (95%CI 4.0-13.9) with a 1-year survival rate of 44.7% (95%CI 29.0-61.5) in the ITT population. Grade 3/4 hematologic toxicities, neutropenia, anemia, and thrombocytopenia were observed in 13 (37.1%), 9 (25.7%), 2 (5.7%), and 2 (5.7%) patients, respectively. One patient experienced a grade 3 febrile neutropenia without any documented infection. The grade 3/4 non-hematologic toxicities were hepatic toxicity (11.4%), anorexia (2.9%), and renal toxicity (2.9%).

Conclusion: Gemcitabine and S-1 combination chemotherapy showed acceptable efficacy and favorable toxicity profiles. Therefore, it might offer an alternative therapeutic strategy in patients with BTC.
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http://dx.doi.org/10.1007/s00280-015-2687-xDOI Listing
April 2015

Useful equation for proper estimate of left side peripherally inserted central venous catheter length in relation to the height.

J Vasc Access 2015 Jan-Feb;16(1):42-6. Epub 2014 Oct 16.

1 Department of Radiology, College of Medicine, Hallym University, Anyang-city, Kyungki-do - Republic of Korea.

Purpose: Direct measurement of venous length is easy to cause contamination during bedside insertion of peripherally inserted central venous catheter (PICC). It is necessary to provide an equation for proper estimate of catheter length in case of bedside insertion of PICC in relation to patient height.

Methods: For 165 PICC cases through left arm vein in 151 adult patients (male: female = 72:79), the cubital crease to carina length (CCL) was calculated as follows: CCL = (distance from cubital crease to puncture point) + (length of PICC inside body) - (distance from carina to catheter tip on post-procedural chest radiograph). We analyzed the relationship between CCL and height with regression analysis and suggest a new equation of CCL based on height.

Results: The mean CCL through the left arm vein was 47.1 ± 2.6 cm in male and 44.0 ± 2.9 cm in female. CCL was significantly correlated with patient height. Equation of CCL (cm) based on height was as follows: CCL = height * 0.19 + 14.

Conclusions: The equation of our study would provide a new equation for proper estimation of catheter length in case of bedside insertion of left arm PICC in relation to height and be helpful for optimal positioning of catheter tip of PICC.
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http://dx.doi.org/10.5301/jva.5000309DOI Listing
November 2015

The usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging in hepatocellular carcinoma: toward improved staging.

Ann Surg Oncol 2015 Mar 9;22(3):819-25. Epub 2014 Sep 9.

Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea,

Purpose: This study was designed to evaluate the usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) in staging hepatocellular carcinoma (HCC).

Methods: This study was approved by the institutional review board of our institution. Two investigators independently and retrospectively reviewed dynamic computed tomography (CT) and gadoxetic acid-enhanced dynamic MRI obtained from July to September 2011 in 195 patients with HCC (158 men, 37 women; mean age, 57.1 years). The diagnostic performances of dynamic CT and MRI were evaluated. Barcelona Clinic Liver Cancer (BCLC) stages were determined before and after gadoxetic acid-enhanced dynamic MRI and according to final diagnosis. Change in BCLC stage was evaluated after adding gadoxetic acid-enhanced dynamic MRI to dynamic CT. Diagnostic performance and BCLC staging between the two modalities were compared using the McNemar test.

Results: Final BCLC stage was classified as stage 0 in 25 patients (12.8%), A in 118 (60.5%), B in 33 (16.9%), C in 17 (8.7%), and D in 2 (1.0%). Compared with dynamic CT, gadoxetic acid-enhanced dynamic MRI showed significantly greater sensitivity (90.6% [203/224] vs. 79.5 % [178/224]; P < 0.0001) and significantly more accurate BCLC staging (92.8% [181/195] vs. 80.5% [157/195]; P < 0.0001). BCLC stage was changed correctly after gadoxetic acid-enhanced dynamic MRI in 13.8% (27/195) patients showing differences between CT and final BCLC stages.

Conclusions: Gadoxetic acid-enhanced dynamic MRI provided important additional information compared with dynamic CT during initial staging workups in patients with HCC. Gadoxetic acid-enhanced dynamic MRI showed higher diagnostic performance and more accurate BCLC staging than dynamic CT.
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http://dx.doi.org/10.1245/s10434-014-4074-yDOI Listing
March 2015

Comparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer.

Chin J Cancer Res 2013 Dec;25(6):689-94

Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 431-070, South Korea;

Objective: Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0 (RECIST 1.0) was proposed as a new guideline for evaluating tumor response and has been widely accepted as a standardized measure. With a number of issues being raised on RECIST 1.0, however, a revised RECIST guideline version 1.1 (RECIST 1.1) was proposed by the RECIST Working Group in 2009. This study was conducted to compare CT tumor response based on RECIST 1.1 vs. RECIST 1.0 in patients with advanced gastric cancer (AGC).

Methods: We reviewed 61 AGC patients with measurable diseases by RECIST 1.0 who were enrolled in other clinical trials between 2008 and 2010. These patients were retrospectively re-analyzed to determine the concordance between the two response criteria using the κ statistic.

Results: The number and sum of tumor diameters of the target lesions by RECIST 1.1 were significantly lower than those by RECIST 1.0 (P<0.0001). However, there was excellent agreement in tumor response between RECIST 1.1 and RECIST 1.0 (κ=0.844). The overall response rates (ORRs) according to RECIST 1.0 and RECIST 1.1 were 32.7% (20/61) and 34.5% (20/58), respectively. One patient with partial response (PR) based on RECIST 1.0 was reclassified as stable disease (SD) by RECIST 1.1. Of two patients with SD by RECIST 1.0, one was downgraded to progressive disease and the other was upgraded to PR by RECIST 1.1.

Conclusions: RECIST 1.1 provided almost perfect agreement with RECIST 1.0 in the CT assessment of tumor response of AGC.
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http://dx.doi.org/10.3978/j.issn.1000-9604.2013.11.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872539PMC
December 2013

Multidetector CT findings of bowel transection in blunt abdominal trauma.

Korean J Radiol 2013 Jul-Aug;14(4):607-15. Epub 2013 Jul 17.

Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 150-950, Korea.

Objective: Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma.

Materials And Methods: We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage.

Results: The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection.

Conclusion: Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.
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http://dx.doi.org/10.3348/kjr.2013.14.4.607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725355PMC
July 2014

Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy.

Eur Radiol 2013 Dec 28;23(12):3345-53. Epub 2013 Jun 28.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea.

Objective: To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects.

Methods: One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm(2)) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC150-1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis.

Results: DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (Az = 0.910) was superior to that of T2-weighed MR tumour volumetry (Az = 0.792) and post-CRT ADC (Az = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively.

Conclusion: DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.
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http://dx.doi.org/10.1007/s00330-013-2936-5DOI Listing
December 2013

Compression of the main pancreatic duct by the intrapancreatic-replaced common hepatic artery.

Korean J Radiol 2013 May-Jun;14(3):412-5. Epub 2013 May 2.

Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Anyang 431-070, Korea.

We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.
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http://dx.doi.org/10.3348/kjr.2013.14.3.412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655293PMC
April 2014

Laparoscopic treatment for post-cholecystectomy Mirizzi syndrome.

Korean J Hepatobiliary Pancreat Surg 2013 May 31;17(2):79-82. Epub 2013 May 31.

Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

The remnant cystic duct or gallbladder neck calculus may rarely result in post-cholecystectomy Mirizzi syndrome. Various managements have been proposed for the treatment of post-cholecystectomy Mirizzi syndrome. Some previous cases of post-cholecystectomy Mirizzi syndrome have been managed with open cholecystectomy and endoscopically. We report a case of a laparoscopic stone removal of post-cholecystectomy Mirizzi syndrome that developed 7 months after laparoscopic cholecystectomy. To our knowledge, this is the first case of laparoscopic management of post-cholecystectomy Mirizzi syndrome. The mechanism, diagnosis and treatment of post-cholecystectomy Mirizzi syndrome are discussed.
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http://dx.doi.org/10.14701/kjhbps.2013.17.2.79DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304496PMC
May 2013

Agenesis of bilateral internal carotid artery associated with basilar artery fenestration mimicking intra-arterial thrombus: a case report.

Vasc Endovascular Surg 2010 Jan 16;44(1):69-74. Epub 2009 Nov 16.

Department of Diagnostic Radiology, The Armed Forces Yangju Hospital, Yangju, Gyenggido, The Republic of Korea.

Bilateral internal carotid artery agenesis is a very rare congenital anomaly, which may be accompanied by various types of associated vascular abnormalities, included intracranial aneurysms or dolichoectatic change of posterior circulation. In this article, we present unique, and to the best of our knowledge, the first case of bilateral internal carotid agenesis associated with basilar artery fenestration, which resembles intra-arterial floating thrombus.
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http://dx.doi.org/10.1177/1538574409347393DOI Listing
January 2010

Head and neck vascular lesions: characterization of the flow pattern by the use of three-phase CT.

Korean J Radiol 2009 Jul-Aug;10(4):323-32. Epub 2009 Jun 24.

Department of Radiology, East-West Neomedical Center, Kyung Hee University, College of Medicine, Seoul, Korea.

Objective: This study was designed to evaluate the usefulness of three-phase CT to characterize the hemodynamics of vascular lesions in the head and neck area.

Materials And Methods: We analyzed vascular malformations of head and neck regions in 21 patients with the use of three-phase CT, including pre-contrast phase, vascular phase (scan delay: 20-35 seconds after intravenous contrast material injection) and equilibrium phase (scan delay: 3-5 minutes) imaging. The flow characteristic of each lesion was determined and categorized as either a high- or a low-flow lesion according to findings on selective arteriography and/or direct puncture venography. The CT number was acquired from two areas in a vascular lesion, sorted by the enhancement pattern: area 1, a highly enhanced area seen on the vascular phase; area 2, a delayedly enhanced area seen on the equilibrium phase. The CT numbers of each phase were compared between high- and low-flow lesions with use of the unpaired t-test. The flow patterns of high- and low-flow lesions were analyzed by assessment of time-density curves of three phase CT.

Results: High-flow lesions were detected in nine patients and low-flow lesions were detected in 12 patients. On the vascular phase, the CT number of areas 1 and 2 of high-flow lesions was significantly higher than for low-flow lesions (p < 0.05). Contrary to early peaks seen in time-density curves of high-flow lesions, low-flow lesions showed a delayed peak.

Conclusion: Three-phase CT seems to be a valuable non-invasive method to differentiate a high-flow lesion from a low flow lesion of head and neck vascular lesions.
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http://dx.doi.org/10.3348/kjr.2009.10.4.323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702040PMC
October 2009

Measurement of kidney volume with multi-detector computed tomography scanning in young Korean.

Yonsei Med J 2009 Apr;50(2):262-5

Department of Internal Medicine, The Armed Forces Yang-Ju Hospital, Yangju, Korea.

Purpose: Kidney volume is regarded as the most precise indicator of kidney size. However, it is not widely used clinically, because its measurement is difficult due to the complex kidney shape. We attempted to evaluate the normal kidney volume in young Korean men by using multi-detector computed tomography (MDCT).

Materials And Methods: We retrospectively reviewed MDCT data of young Korean men (113 patients). After data processing, we measured the volume and length of the kidneys. Body parameters (height, body weight, body-surface area, and total body water) and laboratory data were collected. Glomerular filtration rate (GFR) was calculated using Cockcroft-Gault (CG) equation.

Results: The mean kidney volume was 205.29 +/- 36.81 cm(3); and mean kidney length was 10.80 +/- 0.69 cm. The former correlated significantly with height, body weight, body-surface area, and total body water (p < 0.05, correlation coefficient : gamma = 0.328, 0.649, 0.640, and 0.638, respectively). The latter also correlated significantly with all body indexes, however the correlation was weaker, except with height (p < 0.05, correlation coefficient : gamma = 0.457, 0.473, 0.505, and 0.503, respectively). Only kidney volume significantly predicted estimated GFR (adjusted R(2) = 0.431, F = 85.90 and p < 0.05).

Conclusion: The kidney volume measured with MDCT is correlated well with body parameters, and is useful to predict renal function.
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http://dx.doi.org/10.3349/ymj.2009.50.2.262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679189PMC
April 2009

Imaging of Marfan syndrome: multisystemic manifestations.

Radiographics 2007 Jul-Aug;27(4):989-1004

Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2 dong, Songpa-gu, Seoul 138-736, Korea.

Marfan syndrome is an inherited multisystemic connective-tissue disease that is caused by a mutation of the fibrillin-1 gene. The syndrome is characterized by a wide range of clinical manifestations. Common cardiovascular manifestations, most of which are substantial contributors to mortality, include annuloaortic ectasia with or without aortic valve insufficiency, aortic dissection, aortic aneurysm, pulmonary artery dilatation, and mitral valve prolapse. Scoliosis, pectus excavatum and carinatum, arachnodactyly, and acetabular protrusion are common musculoskeletal manifestations. Dural ectasia is a characteristic central nervous system manifestation. In some patients with Marfan syndrome, there is also pulmonary and ocular involvement. Early identification and treatment of these conditions contribute to an improved quality of life and a life expectancy close to the average for the general population in the United States. Radiologists play a key role in the diagnosis of Marfan syndrome. Knowledge about the various manifestations of Marfan syndrome and awareness of their radiologic appearances permit a comprehensive diagnostic approach that allows better patient care.
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http://dx.doi.org/10.1148/rg.274065171DOI Listing
August 2007

Effects of high-resolution CT of the lung using partial versus full reconstruction on motion artifacts and image noise.

AJR Am J Roentgenol 2006 Sep;187(3):618-22

Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul, South Korea 138-736.

Objective: The purpose of our study was to evaluate the effects of 0.3-second high-resolution CT (HRCT) of the lung using partial reconstruction on cardiac motion artifacts and image noise.

Subjects And Methods: Thirty-seven pairs of 0.3-second (partial reconstruction) and 0.75-second (full reconstruction) HRCT images were obtained for the lower lung zone during full-inspiration breath-holding. Imaging parameters other than temporal resolution were identical for each patient. Two radiologists visually graded motion artifacts of the cardiac border, bronchi, pulmonary vessels, and fissure in the left lung on a 4-point scale (with 4 indicating no artifacts). The maximum width of motion along the left cardiac border and the area percentage of motion artifacts in the left lung were calculated. Image noise in the air and lung was also determined. Cardiac motion artifacts and image noises were compared between the two sets of CT images.

Results: Visual grades for the cardiac border (4 +/- 0), bronchi (3.8 +/- 0.7), pulmonary vessels (3.6 +/- 0.8), and fissure (3.9 +/- 0.5) were higher for 0.3-second images than for 0.75-second images (1.7 +/- 0.7, 2.0 +/- 1.0, 1.6 +/- 0.7, and 2.4 +/- 0.9, respectively) (p < 0.001). The maximum width of motion along the left cardiac border (0.1 +/- 0.5 mm) and the area percentage of motion artifacts in the left lung (6.7% +/- 18.4%) were smaller for 0.3-second images than for 0.75-second images (4.5 +/- 1.7 mm and 36.2% +/- 20.9%, respectively) (p < 0.001). Image noises in the air (38.0 +/- 9.2) and the lung (86.0 +/- 23.1) were greater for 0.3-second images than for 0.75-second images (35.6 +/- 9.6 and 76.0 +/- 20.3, respectively) (p < 0.01).

Conclusion: Compared with 0.75-second HRCT using full reconstruction, 0.3-second HRCT using partial reconstruction substantially reduces cardiac motion artifacts in the lung at the expense of increasing image noise.
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http://dx.doi.org/10.2214/AJR.05.0852DOI Listing
September 2006