Publications by authors named "Sang Hyun Choi"

135 Publications

Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients.

Liver Int 2021 Nov 24. Epub 2021 Nov 24.

Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea.

Background & Aims: We aimed to compare the performance of gadoxetic acid-enhanced abbreviated MRI (AMRI)-based surveillance and ultrasound-only surveillance in high-risk patients for hepatocellular carcinoma (HCC).

Methods: Prospectively recruited high-risk patients (>5% annual risk of HCC) who underwent one to three rounds of complete gadoxetic acid-enhanced MRI (CMRI) and ultrasound at 6-months intervals were retrospectively analysed. AMRI consisted of diffusion-weighted, T2-weighted, and hepatobiliary phase imaging. The sensitivity, specificity, and accuracy of CMRI followed by AMRI (CAA), AMRI-only (AAA), and ultrasound-only (US) were compared using generalized estimating equations. Image quality was assessed.

Results: In 382 patients, HCC was diagnosed in 43 (11.3%), including 42 with early-stage HCCs. The sensitivities of CAA (90.7%, 39/43) and AAA (86.0%, 37/43) were higher than US (27.9% [12/43]; P < 0.001), whereas the sensitivities of the two MRI approaches did not significantly differ (P = 0.56). The specificity of CAA (97.1%, 983/1012) was higher than AAA (95.6% [967/1012]; P = 0.01) and not significantly different from US (96.3% [975/1012]; P = 0.59). The CAA approach had the best accuracy of 96.9% (1022/1055), higher than the AAA approach (95.2% [1004/1055]; P = 0.01) and the US approach (93.6% [987/1055]; P = 0.01). Image quality was inadequate in 33.7% (356/1055) of US examinations but in only 10.0% (105/1055) of the AAA and 11.1% (117/1055) of the CAA approach.

Conclusions: In high-risk patients, AMRI-based surveillance approaches had higher sensitivities than ultrasound-only surveillance for early-stage HCC. A sequential MRI approach of CMRI followed by AMRIs showed superior accuracy than the AMRI-only or ultrasound-only approach.
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http://dx.doi.org/10.1111/liv.15110DOI Listing
November 2021

CT/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma: Individual Patient Data Meta-Analysis.

Radiology 2021 Nov 16:211244. Epub 2021 Nov 16.

From the Dept of Diagnostic Imaging, Juravinski Hosp and Cancer Centre, Hamilton Health Sciences, McMaster Univ, Hamilton, Canada (C.B.v.d.P.); Dept of Radiology and Epidemiology, Univ of Ottawa, Ottawa, Canada (M.D.F.M.); Ottawa Hosp Research Inst Clinical Epidemiology Program, Dept of Medical Imaging, the Ottawa Hosp-Civic Campus, 1053 Carling Ave, Room c-159, Ottawa, ON, Canada K1E 4Y9 (M.D.F.M.); Faculty of Health Sciences, Queen's Univ, Kingston, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hosp Research Inst, Ottawa, Canada (J.P.S.); Centre for Prognosis Research, School of Medicine, Keele Univ, Staffordshire, UK (B.L.); Dept of Radiology, Montefiore Medical Ctr, Bronx, NY (V.C.); Liver Imaging Group, Dept of Radiology, Univ of California San Diego, San Diego, Calif (C.B.S.); Depts of Radiology (M.R.B., B.C.A.) and Medicine (M.R.B.) and Ctr for Advanced Magnetic Resonance Development (M.R.B.), Duke Univ Medical Ctr, Durham, NC; Dept of Radiology, Univ of North Carolina, Chapel Hill, NC (M.R.B., L.M.B.B., K.A.M.); Dept of Radiology, Research Inst of Radiological Science, Yonsei Univ College of Medicine, Seoul, Korea (J.Y.C., M.J.K., Y.Y.K., M.S.P.); Asan Medical Ctr, Univ of Ulsan College of Medicine, Seoul, Korea (S.H.C.); BCLC Group, Liver Unit, Hosp Clínic of Barcelona, Barcelona, Spain (A.F.); IDIBAPS, CIBERehd, Univ of Barcelona, Barcelona, Spain (A.F.); Mallinckrodt Inst of Radiology, Washington Univ School of Medicine, St Louis, Mo (T.J.F.); Div of Internal Medicine, Hepatobiliary and Immunoallergic Diseases (A.G., F.P., E.T.), and Emergency Dept, Medicina d'Urgenza e Pronto Soccorso (L.M.), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dept of Radiology, West China Hosp, Sichuan Univ, Chengdu, China (H.J.); Dept of Radiology (I.J., H.J.K., J.H.K., J.M.L.) and Inst of Radiation Medicine (J.H.K., J.M.L.), Seoul National Univ Hosp, Seoul, Korea; Dept of Radiology, Seoul National Univ College of Medicine, Seoul, Korea (I.J., J.H.K., J.M.L.); Dept of Radiology, Tongji Hosp, Tongji Medical College, Wuhan, China (Z.K.); Huazhong Univ of Science and Technology, Wuhan, China (Z.K.); Dept of Radiology, Weill Cornell Medical Ctr, New York, NY (A.S.K.); Dept of Radiology (G.K., T.Y.) and Advanced Imaging Research Ctr (T.Y.), Univ of Texas Southwestern Medical Ctr, Dallas, Tex; Dept of Radiology and Research Inst of Radiology, Univ of Ulsan College of Medicine, Asan Medical Ctr, Seoul, Korea (S.Y.K.); Dept of Radiology, Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea (H.K.); Dept of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); 2nd Radiology Dept, Warsaw Medical Univ, Warsaw, Poland (J.P., G.R.); Inst of Diagnostic and Interventional Radiology, Univ Hosp Zurich, Zurich, Switzerland (C.S.R.); Dept of Radiology, Beaujon Hosp, APHP.Nord, Clichy, France (M.R.); Université de Paris, Paris, France (M.R.); Dept of Radiology, West China Hosp, Sichuan Univ, Chengdu, China (B.S.); Dept of Radiology, Jeonbuk National Univ Medical School and Hosp, Jeonju, Korea (J.S.S.); Dept of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (A.T.); Dept of Radiology, the Third Affiliated Hosp, Sun Yat-sen Univ, Guangzhou, China (J.W.); Dept of Medical Ultrasonics, Inst of Diagnostic and Interventional Ultrasound, the First Affiliated Hosp of Sun Yat-Sen Univ, Guangzhou, China (W.W.); Depts of Radiology and Medicine, Div of Gastroenterology, Univ of Calgary, Calgary, Canada (S.R.W.); and Foothills Medical Centre, Calgary, Canada (S.R.W.).

Background The Liver Imaging Reporting and Data System (LI-RADS) assigns a risk category for hepatocellular carcinoma (HCC) to imaging observations. Establishing the contributions of major features can inform the diagnostic algorithm. Purpose To perform a systematic review and individual patient data meta-analysis to establish the probability of HCC for each LI-RADS major feature using CT/MRI and contrast-enhanced US (CEUS) LI-RADS in patients at high risk for HCC. Materials and Methods Multiple databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched for studies from January 2014 to September 2019 that evaluated the accuracy of CT, MRI, and CEUS for HCC detection using LI-RADS (CT/MRI LI-RADS, versions 2014, 2017, and 2018; CEUS LI-RADS, versions 2016 and 2017). Data were centralized. Clustering was addressed at the study and patient levels using mixed models. Adjusted odds ratios (ORs) with 95% CIs were determined for each major feature using multivariable stepwise logistic regression. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (PROSPERO protocol: CRD42020164486). Results A total of 32 studies were included, with 1170 CT observations, 3341 MRI observations, and 853 CEUS observations. At multivariable analysis of CT/MRI LI-RADS, all major features were associated with HCC, except threshold growth (OR, 1.6; 95% CI: 0.7, 3.6; = .07). Nonperipheral washout (OR, 13.2; 95% CI: 9.0, 19.2; = .01) and nonrim arterial phase hyperenhancement (APHE) (OR, 10.3; 95% CI: 6.7, 15.6; = .01) had stronger associations with HCC than enhancing capsule (OR, 2.4; 95% CI: 1.7, 3.5; = .03). On CEUS images, APHE (OR, 7.3; 95% CI: 4.6, 11.5; = .01), late and mild washout (OR, 4.1; 95% CI: 2.6, 6.6; = .01), and size of at least 20 mm (OR, 1.6; 95% CI: 1.04, 2.5; = .04) were associated with HCC. Twenty-five studies (78%) had high risk of bias due to reporting ambiguity or study design flaws. Conclusion Most Liver Imaging Reporting and Data System major features had different independent associations with hepatocellular carcinoma; for CT/MRI, arterial phase hyperenhancement and washout had the strongest associations, whereas threshold growth had no association. © RSNA, 2021
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http://dx.doi.org/10.1148/radiol.2021211244DOI Listing
November 2021

Whole-Brain Mapping of the Expression Pattern of , a Subunit Specific to the Sweet Taste Receptor.

Front Neuroanat 2021 28;15:751839. Epub 2021 Oct 28.

BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea.

Chemosensory receptors are expressed primarily in sensory organs, but their expression elsewhere can permit ligand detection in other contexts that contribute to survival. The ability of sweet taste receptors to detect natural sugars, sugar alcohols, and artificial sweeteners suggests sweet taste receptors are involved in metabolic regulation in both peripheral organs and in the central nervous system. Our limited knowledge of sweet taste receptor expression in the brain, however, has made it difficult to assess their contribution to metabolic regulation. We, therefore, decided to profile the expression pattern of T1R2, a subunit specific to the sweet taste receptor complex, at the whole-brain level. Using knock-in mice, we visualized the overall distribution of -labeled cells in the brain. is expressed not only in various populations of neurons, but also in glial populations in the circumventricular organs and in vascular structures in the cortex, thalamus, and striatum. Using immunohistochemistry, we found that is expressed in hypothalamic neurons expressing neuropeptide Y and proopiomelanocortin in arcuate nucleus. It is also co-expressed with a canonical taste signaling molecule in perivascular cells of the median eminence. Our findings indicate that sweet taste receptors have unidentified functions in the brain and suggest that they may be a novel therapeutic target in the central nervous system.
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http://dx.doi.org/10.3389/fnana.2021.751839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581048PMC
October 2021

Inter-reader agreement of abbreviated magnetic resonance imaging for hepatocellular carcinoma detection: a systematic review and meta-analysis.

Abdom Radiol (NY) 2021 Oct 11. Epub 2021 Oct 11.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Purpose: To determine the inter-reader agreement of abbreviated magnetic resonance imaging (AMRI) for the detection of hepatocellular carcinoma (HCC) and explore the causes of heterogeneity between the reported results.

Methods: Original studies reporting the inter-reader agreement of AMRI for detecting HCC were identified in MEDLINE, EMBASE, and Cochrane databases. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses were performed according to the AMRI protocol (non-contrast [NC]-AMRI, dynamic contrast-enhanced [DCE]-AMRI, and hepatobiliary phase [HBP]-AMRI). Meta-regression analyses were performed to further explore study heterogeneity.

Results: In the eight included studies (1182 patients), the overall pooled κ was 0.76 (95% confidence interval [CI], 0.70-0.82; I = 74.4%). The κ of NC-AMRI, DCE-AMRI, and HBP-AMRI were 0.72 (95% CI, 0.62-0.82), 0.80 (95% CI, 0.78-0.82), and 0.98 (95% CI, 0.95-1.00), respectively. In the NC-AMRI, the pooled κ of NC-AMRI using only diffusion-weighted imaging (DWI) was 0.64, which was lower than the values using two or more imaging sequences (κ = 0.74-0.77). In subgroup analysis, no study heterogeneity was noted in studies using DCE-AMRI (I = 0%), whereas high heterogeneity was noted with NC-AMRI (I = 80.5%). Especially, NC-AMRI including more than two imaging sequences showed high residual heterogeneity (I = 87.6%). Meta-regression analysis found that difference in reader experience was significantly associated with study heterogeneity (p = .02).

Conclusion: AMRI for detecting HCC showed substantial inter-reader agreement across all examined protocols. NC-AMRI, notably NC-AMRI using only DWI, had relatively low inter-reader agreement. Therefore, DCE-AMRI or HBP-AMRI may be more reliable than NC-AMRI using only DWI.
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http://dx.doi.org/10.1007/s00261-021-03297-0DOI Listing
October 2021

Vascular reactivity contributes to adipose tissue remodeling in obesity.

J Endocrinol 2021 Nov 8;251(3):195-206. Epub 2021 Nov 8.

BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.

Vascular reactivity of adipose tissue (AT) is hypothesized to play an important role in the development of obesity. However, the exact role of vascular reactivity in the development of obesity remains unclear. In this study, we investigated the chronological changes in vascular reactivity and the microenvironments of the visceral AT (VAT) and subcutaneous AT (SAT) in lean and obese mice. Changes in blood flow levels induced by a β-adrenoceptor agonist (isoproterenol) were significantly lower in the VAT of the mice fed a high-fat diet (HFD) for 1 and 12 weeks than those in the VAT of the mice fed a low-fat diet (LFD) for the same period; no significant change was observed in the SAT of any mouse group, suggesting depot-specific vascular reactivity of AT. Moreover, the hypoxic area and the expression of genes associated with angiogenesis and macrophage recruitment were increased in the VAT (but not in the SAT) of mice fed an HFD for 1 week compared with mice fed an LFD. These changes occurred with no morphological changes, including those related to adipocyte size, AT vessel density, and the diameter and pericyte coverage of the endothelium, suggesting a determinant role of vascular reactivity in the type of AT remodeling. The suppression of vascular reactivity was accompanied by increased endothelin1 (Edn1) gene expression and extracellular matrix (ECM) stiffness only in the VAT, implying enhanced contractile activities of the vasculature and ECM. The results suggest a depot-specific role of vascular reactivity in AT remodeling during the development of obesity.
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http://dx.doi.org/10.1530/JOE-21-0187DOI Listing
November 2021

Magnetic Resonance Imaging for Surveillance of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Diagnostics (Basel) 2021 Sep 12;11(9). Epub 2021 Sep 12.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Our meta-analysis aimed to evaluate the diagnostic performance of surveillance magnetic resonance imaging (sMRI) for detecting hepatocellular carcinoma (HCC), and to compare the diagnostic performance of sMRI between different protocols. Original articles about the diagnostic accuracy of sMRI for detecting HCC were found in major databases. The meta-analytic pooled sensitivity and specificity of sMRI for detecting HCC were determined using a bivariate random effects model. The pooled sensitivity and specificity of full MRI and abbreviated MRI protocols were compared using bivariate meta-regression. In the total seven included studies (1830 patients), the pooled sensitivity of sMRI for any-stage HCC and very early-stage HCC were 85% (95% confidence interval, 79-90%; = 0%) and 77% (66-85%; = 32%), respectively. The pooled specificity for any-stage HCC and very early-stage HCC were 94% (90-97%; = 94%) and 94% (88-97%; = 96%), respectively. The pooled sensitivity and specificity of abbreviated MRI protocols were 87% (80-94%) and 94% (90-98%), values that were comparable with those of full MRI protocols (84% [76-91%] and 94% [89-99%]; = 0.83). In conclusion, sMRI had good sensitivity for detecting HCC, particularly very early-stage HCC. Abbreviated MRI protocols for HCC surveillance had comparable diagnostic performance to full MRI protocols.
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http://dx.doi.org/10.3390/diagnostics11091665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469328PMC
September 2021

Is the Mixed Use of Magnetic Resonance Enterography and Computed Tomography Enterography Adequate for Routine Periodic Follow-Up of Bowel Inflammation in Patients with Crohn's Disease?

Korean J Radiol 2021 Sep 13. Epub 2021 Sep 13.

Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are considered substitutes for each other for evaluating Crohn's disease (CD). However, the adequacy of mixing them for routine periodic follow-up for CD has not been established. This study aimed to compare MRE alone with the mixed use of CTE and MRE for the periodic follow-up of small bowel inflammation in patients with CD.

Materials And Methods: We retrospectively compared two non-randomized groups, each comprising 96 patients with CD. One group underwent CTE and MRE (MRE followed by CTE or vice versa) for the follow-up of CD (interval, 13-27 months [median, 22 months]), and the other group underwent MRE alone (interval, 15-26 months [median, 21 months]). However, these two groups were similar in clinical characteristics. Three independent readers from three different institutions determined whether inflammation had decreased, remained unchanged, or increased within the entire small bowel and the terminal ileum based on sequential enterography of the patients after appropriate blinding. We compared the two groups for inter-reader agreement and accuracy (terminal ileum only) using endoscopy as the reference standard for enterographic interpretation.

Results: The inter-reader agreement was greater in the MRE alone group for the entire small bowel (intraclass correlation coefficient [ICC]: 0.683 vs. 0.473; = 0.005) and the terminal ileum (ICC: 0.656 vs. 0.490; = 0.030). The interpretation accuracy was higher in the MRE alone group without statistical significance (70.9%-74.5% vs. 57.9%-64.9% in individual readers; adjusted odds ratio = 3.21; = 0.077).

Conclusion: The mixed use of CTE and MRE was inferior to MRE alone in terms of inter-reader reliability and could probably be less accurate than MRE alone for routine monitoring of small bowel inflammation in patients with CD. Therefore, the consistent use of MRE is favored for this purpose.
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http://dx.doi.org/10.3348/kjr.2021.0072DOI Listing
September 2021

Clinical Staging of Mass-Forming Intrahepatic Cholangiocarcinoma: Computed Tomography Versus Magnetic Resonance Imaging.

Hepatol Commun 2021 Dec 24;5(12):2009-2018. Epub 2021 Aug 24.

Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

We compared the performance of computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative clinical staging of mass-forming intrahepatic cholangiocarcinoma (iCCA), using the eighth American Joint Committee on Cancer (AJCC) system. This retrospective, multicenter, cohort study consecutively identified patients who underwent partial hepatectomy for mass-forming iCCA and had preoperative CT and MRI performed from January 2009 to December 2015. CT and MRI characteristics were used to determine clinical stage based on the eighth AJCC system. Performances of CT and MRI for clinical T and N staging were compared using generalized estimating equations. In 334 patients (median age, 63 years; 221 men), MRI sensitivities were significantly higher than CT sensitivities for detecting T1b or higher stages (91.0% vs. 80.5%, respectively, P < 0.001), T2 or higher stages (89.1% vs. 73.8%, respectively, P < 0.001), and T3 or T4 stage (77.8% vs. 58.0%, respectively, P < 0.001). MRI was also more sensitive at identifying multiple tumors than CT (66.7% vs. 50.0%, respectively, P = 0.026), without a significant difference in specificity (78.1% vs. 80.1%, respectively, P = 0.342). Sensitivities were comparable between CT and MRI for determination of size >5 cm (i.e., T1b for single tumor) and extrahepatic organ invasion (i.e., T4). Sensitivities of CT and MRI were not different for N stage (65.0% vs. 64.0%, respectively, P = 0.808), but the specificity of CT was significantly higher than that of MRI (80.7% vs. 72.9%, respectively, P = 0.001) when using a composite reference standard. Conclusion: MRI showed superior sensitivity to CT for diagnosing T2 and T3 stages, particularly multiple tumors. CT and MRI had comparable sensitivity for N staging, but CT provided higher specificity than MRI.
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http://dx.doi.org/10.1002/hep4.1774DOI Listing
December 2021

Inadequate Ultrasound Examination in Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis.

J Clin Med 2021 Aug 12;10(16). Epub 2021 Aug 12.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.

We aimed to systematically evaluate the incidence of inadequate US in hepatocellular carcinoma (HCC) surveillance and determine the risk factors. Original studies reporting the incidence or risk factors for inadequate US were identified in MEDLINE, EMBASE, and the Cochrane database. The pooled incidence of inadequate US was calculated using a random effects model, and subgroup analyses were performed. The pooled odds ratio (OR) was calculated for each risk factor for inadequate US. Six eligible articles were identified from 756 screened articles (4250 patients). The pooled incidence of inadequate US was 21.5%. Significantly higher rates of inadequate US were noted in studies including patients with and without hepatic observations compared with those evaluating only patients with hepatic observations (23.2% vs. 18.8%), studies using US alone compared with US plus alpha-fetoprotein (28.0% vs. 20.8%), and those using pathology and imaging as a reference standard compared with imaging only (23.2% vs. 17.9%). Nonalcoholic steatohepatitis (OR = 2.3 (1.07-4.84)), Child-Pugh B cirrhosis (OR = 2.2 (1.10-4.37)), and high body mass index (OR = 2.2 (1.12-4.24)) were significant risk factors for inadequate US ( ≤ 0.04). In patients at risk of HCC, 21.5% of US surveillance was inadequate. An alternative surveillance modality might be considered in patients with risk factors.
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http://dx.doi.org/10.3390/jcm10163535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397222PMC
August 2021

Accuracy of the ultrasound attenuation coefficient for the evaluation of hepatic steatosis: a systematic review and meta-analysis of prospective studies.

Ultrasonography 2021 Jun 1. Epub 2021 Jun 1.

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

Purpose: The accurate detection and quantification of hepatic steatosis using a noninvasive method are important for the management of nonalcoholic fatty liver disease. We performed a systematic review and meta-analysis of the accuracy of the ultrasound-measured attenuation coefficient (AC) in the evaluation of hepatic steatosis.

Methods: The PubMed, Embase, and Cochrane databases were searched for prospective studies reporting the diagnostic accuracy of AC for assessing hepatic steatosis. The meta-analytic pooled sensitivity and specificity of AC for any grade of steatosis (S≥1) and advanced steatosis (S≥2) were estimated using a bivariate random-effects model. Meta-regression analysis was conducted to investigate the causes of heterogeneity among studies.

Results: Thirteen studies including 1,509 patients were identified. The pooled sensitivity and specificity of AC for S≥1 were 76% (95% confidence interval [CI], 73% to 80%; I2=43%) and 84% (95% CI, 77% to 89%; I2=74%), respectively, while for S≥2 they were 87% (95% CI, 83% to 91%; I2=0%) and 79% (95% CI, 75% to 83%; I2=59%), respectively. Study heterogeneity was associated with body mass index (BMI) and the prevalence of steatosis or significant fibrosis.

Conclusion: AC can be clinically useful for assessing hepatic steatosis, with good overall diagnostic performance. The data reported in the published literature differed according to BMI and the prevalence of steatosis or significant fibrosis, and careful interpretation with consideration of these factors might be needed.
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http://dx.doi.org/10.14366/usg.21076DOI Listing
June 2021

Thermal ablation in the treatment of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.

Eur Radiol 2021 Aug 4. Epub 2021 Aug 4.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.

Objective: To summarize the efficacy and safety of thermal ablation for the treatment of intrahepatic cholangiocarcinoma (ICC).

Methods: MEDLINE, EMBASE, Cochran Library, and Web of Science databases were searched for studies reporting outcomes in patients with ICC treated with thermal ablation. Meta-analyses of cumulative overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier survival rates according to time to local tumor progression (TTLTP), technical efficacy, and incidence of complications were analyzed. Pooled hazard ratios of common variables were calculated to explore factors associated with OS.

Results: Twenty observational studies comprising 917 patients were reviewed (primary ICC [n = 502]; post-surgical recurrent ICC [n = 355]; information not available [n = 60]). The pooled proportion of technical efficacy was 91.9% (95% CI, 87.3-94.9%). The pooled 1-, 3-, and 5-year OS rates were 82.4% (95% CI, 75.1-88.9%), 42.1% (95% CI, 36.0-48.4%), and 28.5% (95% CI, 21.2-36.2%). Primary tumors showed higher 3-year OS rates than recurrent ones, with borderline significance (p = 0.072). The pooled 1- and 3-year RFS rates were 40.0% (95% CI, 33.6-46.4%) and 19.2% (95% CI, 8.4-32.7%). The pooled 1-, 3-, and 5-year TTLTP rates were 79.3% (95% CI, 65.1-90.9%), 59.5% (95% CI, 49.1-69.4%), and 58.2% (95% CI, 44.9-70.9%). The pooled incidence of major complications was 5.7% (95% CI, 4.1-7.8%). Tumor size (> 3 cm), multiple tumors, and age (> 65 years) were factors associated with shorter OS.

Conclusion: Thermal ablation is a successful alternative with a good safety profile, especially for a single ICC smaller than 3 cm.

Key Points: • The pooled 1-, 3-, and 5-year OS rates following thermal ablation for the treatment of intrahepatic cholangiocarcinoma were 82.4%, 42.1%, and 28.5%. • The pooled incidence of major complications was 5.7%. • A tumor size > 3 cm (HR: 2.12, p = 0.006), multiple tumors (HR: 1.67, p = 0.004), and age > 65 years (HR: 1.67, p = 0.006) were factors associated with shorter OS.
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http://dx.doi.org/10.1007/s00330-021-08216-xDOI Listing
August 2021

Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria.

Abdom Radiol (NY) 2021 11 31;46(11):5201-5217. Epub 2021 Jul 31.

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

Purpose: To assess the CT diagnostic performance for evaluating resectability of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy and identify the factor(s) that affect(s) diagnostic performance.

Methods: Databases were searched to identify studies published from January 1, 2000, to November 5, 2019 that evaluated the CT diagnostic performance for assessing resectability of post-neoadjuvant PDAC. Two reviewers independently extracted data and assessed the study quality. A meta-analysis was performed to obtain summary sensitivity and specificity values using a bivariate random-effects model, and heterogeneity across studies was assessed. Univariable meta-regression analysis was performed with eight variables, including the different CT criteria for resectability, conventional National Comprehensive Cancer Network (NCCN) criteria for upfront surgery, and modified criteria for post-neoadjuvant surgery.

Results: Ten studies were included and analyzed. The summary sensitivity and specificity for resectability were 78% (95% CI 68-86%) and 60% (95% CI 44-74%), respectively. No significant heterogeneity was identified (bivariate correlation coefficient ρ = - 1, p-value for hierarchical summary receiver operating characteristics model β = 0.667). The two different CT criteria showed different diagnostic performance (p < 0.01), with higher sensitivity (81% [95% CI 73-90%] vs. 28% [95% CI 15-42%], p < 0.01) and lower specificity (57% [95% CI 41-73%] vs. 90% [95% CI 80-100%], p < 0.01) for the modified criteria. No other variables affected the diagnostic performance.

Conclusion: CT criteria were the factors that affected the diagnostic performance. Modification of the conventional criteria improved sensitivity but lowered specificity. Further modifications are required to improve specificity and uniformity.
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http://dx.doi.org/10.1007/s00261-021-03198-2DOI Listing
November 2021

Transient Severe Motion Artifact on Arterial Phase in Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging: A Systematic Review and Meta-analysis.

Invest Radiol 2021 Jun 30. Epub 2021 Jun 30.

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

Objectives: The aims of this study were to determine the incidence of transient severe motion artifact (TSM) on arterial phase gadoxetic acid-enhanced magnetic resonance imaging of the liver and to investigate the causes of heterogeneity in the published literature.

Materials And Methods: Original studies reporting the incidence of TSM were identified in searches of PubMed, Embase, and Cochrane Library databases. The pooled incidence of TSM was calculated using random-effects meta-analysis of single proportions. Subgroup analyses were conducted to explore causes of heterogeneity.

Results: A total of 24 studies were finally included (single arterial phase, 19 studies with 3065 subjects; multiple arterial phases, 8 studies with 2274 subjects). Studies using single arterial phase imaging reported individual TSM rates varying from 4.8% to 26.7% and a pooled incidence of TSM of 13.0% (95% confidence interval, 10.3%-16.2%), which showed substantial study heterogeneity. The pooled incidence of TSM in the studies using multiple arterial phase imaging was 3.2% (95% confidence interval, 1.9%-5.2%), which was significantly less than in those studies using single arterial phase imaging (P < 0.001). In the subgroup analysis, the geographical region of studies and the definition of TSM were found to be causes of heterogeneity. The incidence of TSM was higher in studies with Western populations from Europe or North America than in those with Eastern (Asia/Pacific) populations (16.0% vs 8.8%, P = 0.005). Regarding the definition of TSM, the incidence of TSM was higher when a 4-point scale was used for its categorization than when a 5-point scale was used (20.0% vs 11.0%, P = 0.008), and a definition considering motion artifact on phases other than arterial phase imaging lowered the incidence of TSM compared with it being defined only on arterial phase imaging (11.3% vs 20.3%, P = 0.018).

Conclusions: The incidence of TSM on arterial phase images varied across studies and was associated with the geographical region of studies and the definition of TSM. Careful interpretation of results reporting TSM might therefore be needed.
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http://dx.doi.org/10.1097/RLI.0000000000000806DOI Listing
June 2021

Meta-Analysis of the Accuracy of Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: Non-Contrast versus Hepatobiliary Phase-Abbreviated Magnetic Resonance Imaging.

Cancers (Basel) 2021 Jun 14;13(12). Epub 2021 Jun 14.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

We aimed to determine the performance of surveillance abbreviated magnetic resonance imaging (AMRI) for detecting hepatocellular carcinoma (HCC), and to compare the performance of surveillance AMRI according to different protocols. Original research studies reporting the performance of surveillance AMRI for the detection of HCC were identified in MEDLINE, EMBASE, and Cochrane databases. The pooled sensitivity and specificity of surveillance AMRI were calculated using a hierarchical model. The pooled sensitivity and specificity of contrast-enhanced hepatobiliary phase (HBP)-AMRI and non-contrast (NC)-AMRI were calculated and compared using bivariate meta-regression. Ten studies, including 1547 patients, reported the accuracy of surveillance AMRI. The pooled sensitivity and specificity of surveillance AMRI for detecting any-stage HCC were 86% (95% confidence interval (CI), 80-90%; = 0%) and 96% (95% CI, 93-98%; = 80.5%), respectively. HBP-AMRI showed a significantly higher sensitivity for detecting HCC than NC-AMRI (87% vs. 82%), but significantly lower specificity (93% vs. 98%) ( = 0.03). Study quality and MRI magnet field strength were factors significantly associated with study heterogeneity ( ≤ 0.01). In conclusion, surveillance AMRI showed good overall diagnostic performance for detecting HCC. HBP-AMRI had significantly higher sensitivity for detecting HCC than NC-AMRI, but lower specificity.
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http://dx.doi.org/10.3390/cancers13122975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231787PMC
June 2021

Deletion of adipose triglyceride lipase abolishes blood flow increase after β3-adrenergic stimulation in visceral adipose tissue of mice.

Korean J Physiol Pharmacol 2021 Jul;25(4):355-363

Department of Pharmacology, Korea University College of Medicine, Seoul 02841, Korea.

Dynamic changes in adipose tissue blood flow (ATBF) with nutritional status play a role in the regulation of metabolic and endocrine functions. Activation of the sympathetic nervous system via β-adrenergic receptors (β-AR) contributes to the control of postprandial enhancement of ATBF. Herein, we sought to identify the role of each β-AR subtype in the regulation of ATBF in mice. We monitored the changes in visceral epididymal ATBF (VAT BF), induced by local infusion of dobutamine, salbutamol, and CL316,243 (a selective β1-, β2-, and β3-AR agonist, respectively) into VAT of lean CD-1 mice and global adipose triglyceride lipase (ATGL) knockout (KO) mice, using laser Doppler flowmetry. Administration of CL316,243, known to promote lipolysis in adipocytes, significantly increased VAT BF of CD-1 mice to a greater extent compared to that of the vehicle, whereas administration of dobutamine or salbutamol did not produce significant differences in VAT BF. The increase in VAT BF induced by β3-AR stimulation disappeared in ATGL KO mice as opposed to their wild-type (WT) littermates, implying a role of ATGL-mediated lipolysis in the regulation of VAT BF. Different vascular reactivities occurred despite no significant differences in vessel density and adiposity between the groups. Additionally, the expression levels of the angiogenesis-related genes were significantly higher in VAT of ATGL KO mice than in that of WT, implicating an association of ATBF responsiveness with angiogenic activity in VAT. Our findings suggest a potential role of β3-AR signaling in the regulation of VAT BF ATGL-mediated lipolysis in mice.
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http://dx.doi.org/10.4196/kjpp.2021.25.4.355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255121PMC
July 2021

Inter-reader reliability of contrast-enhanced ultrasound Liver Imaging Reporting and Data System: a meta-analysis.

Abdom Radiol (NY) 2021 10 22;46(10):4671-4681. Epub 2021 Jun 22.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

Purpose: To systematically determine the inter-reader reliability of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS), with emphasis on its major features for hepatocellular carcinoma (HCC) and LR-M (LI-RADS category M) features for non-HCC malignancy.

Methods: MEDLINE, EMBASE, and Cochrane databases were searched from January 2016 to March 2021 to identify original articles reporting the inter-reader reliability of CEUS LI-RADS. Meta-analytic pooled kappa values (κ) were calculated for major features [nonrim arterial-phase hyperenhancement (APHE), mild and late washout], LR-M features (rim APHE, early washout), and LI-RADS categorization using the DerSimonian-Laird random-effects model. Meta-regression analysis was performed to explore any causes of study heterogeneity.

Results: Twelve studies with a total of 2862 lesions were included. The meta-analytic pooled κ of nonrim APHE, mild and late washout, rim APHE, early washout, and LI-RADS categorization were 0.73 [95% confidence interval (CI), 0.67 - 0.79], 0.69 (95% CI, 0.54-0.84), 0.54 (95% CI, 0.37-0.71), 0.62 (95% CI, 0.45-0.79), and 0.75 (95% CI, 0.64-0.87), respectively. Compared with the major features, LR-M features had a lower meta-analytic pooled κ. Substantial study heterogeneity was noted in the LI-RADS categorization, and lesion size (p = 0.03) and the homogeneity in reader experience (p = 0.03) were significantly associated with study heterogeneity.

Conclusions: CEUS LI-RADS showed substantial inter-reader reliability for major features and LI-RADS categorization, but relatively lower reliability was found for LR-M features. In our opinion, the definitions of imaging features require further refinement to improve the inter-reader reliability of CEUS LI-RADS.
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http://dx.doi.org/10.1007/s00261-021-03169-7DOI Listing
October 2021

Radio-pathologic correlation of biphenotypic primary liver cancer (combined hepatocellular cholangiocarcinoma): changes in the 2019 WHO classification and impact on LI-RADS classification at liver MRI.

Eur Radiol 2021 Dec 26;31(12):9479-9488. Epub 2021 May 26.

Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Objectives: To explain the new changes in pathologic diagnoses of biphenotypic primary liver cancer (PLC) according to the updated 2019 World Health Organization (WHO) classification and how it impacts Liver Imaging Reporting and Data System (LI-RADS) classification using gadoxetic acid-enhanced MRI (Gd-EOB-MRI).

Methods: We retrospectively included 209 patients with pathologically proven biphenotypic PLCs according to the 2010 WHO classification who had undergone preoperative Gd-EOB-MRI between January 2009 and December 2018. Imaging analysis including LI-RADS classification and pathologic review including the proportion of tumor components were performed. Frequencies of each diagnosis and subtype according to the 2010 and 2019 WHO classifications were compared, and changes in LI-RADS classification were evaluated. Univariable and multivariable analysis were performed to determine significant tumor component for LI-RADS classification.

Results: Of the 209 biphenotypic PLCs of the 2010 WHO classification, 177 (84.7%) were diagnosed as bipheonotypic PLCs, 25 (12.0%) as hepatocellular carcinomas (HCCs), and 7 (3.3%) as cholangiocarcinomas (CCAs) using the 2019 WHO classification. Of the 177 biphenotypic PLCs, LR-M, LR-4, and LR-5 were assigned in 77 (43.5%), 21 (11.9%), and 63 (35.5%), respectively. There were no significant differences in the proportion of LR-5 and LR-M categories between the WHO 2010 and 2019 classifications (p = 0.941). Proportion of HCC component was the only independent factor for LI-RADS classification (adjusted odds ratio, 1.02; p < 0.001).

Conclusion: According to the 2019 WHO classification, 15% of biphenotypic PLCs from the 2010 WHO classification were re-diagnosed as HCCs or CCAs, and a substantial proportion of biphenotypic PLCs of the 2019 WHO classification could be categorized as LR-4 or LR-5 on Gd-EOB-MRI.

Key Points: • Among 209 diagnosed biphenotypic PLCs according to the 2010 WHO classification, 177 (84.7%) lesions were reclassified as bipheonotypic PLCs, 25 (12.0%) as HCCs, and 7 (3.3%) as CCAs using the 2019 WHO classification. • Of the 177 biphenotypic PLCs at the 2019 WHO classification, LR-M, LR-4, and LR-5 were assigned in 77 (43.5%), 21 (11.9%), and 63 (35.5%), respectively. • LI-RADS classification relied on the proportion of HCC component (adjusted odds ratio,1.02; p < 0.001).
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http://dx.doi.org/10.1007/s00330-021-07984-wDOI Listing
December 2021

MRI Features for Predicting Microvascular Invasion of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Liver Cancer 2021 Apr 11;10(2):94-106. Epub 2021 Mar 11.

Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.

Purpose: Microvascular invasion (MVI) is an important prognostic factor in patients with hepatocellular carcinoma (HCC). However, the reported results of magnetic resonance imaging (MRI) features for predicting MVI of HCC are variable and conflicting. Therefore, this meta-analysis aimed to identify the significant MRI features for MVI of HCC and to determine their diagnostic value.

Methods: Original studies reporting the diagnostic performance of MRI for predicting MVI of HCC were identified in MEDLINE and EMBASE up until January 15, 2020. Study quality was assessed using QUADAS-2. A bivariate random-effects model was used to calculate the meta-analytic pooled diagnostic odds ratio (DOR) and 95% confidence interval (CI) for each MRI feature for diagnosing MVI in HCC. The meta-analytic pooled sensitivity and specificity were calculated for the significant MRI features.

Results: Among 235 screened articles, we found 36 studies including 4,274 HCCs. Of the 15 available MRI features, 7 were significantly associated with MVI: larger tumor size (>5 cm) (DOR = 5.2, 95% CI [3.0-9.0]), rim arterial enhancement (4.2, 95% CI [1.7-10.6]), arterial peritumoral enhancement (4.4, 95% CI [2.8-6.9]), peritumoral hypointensity on hepatobiliary phase imaging (HBP) (8.2, 95% CI [4.4-15.2]), nonsmooth tumor margin (3.2, 95% CI [2.2-4.4]), multifocality (7.1, 95% CI [2.6-19.5]), and hypointensity on T1-weighted imaging (T1WI) (4.9, 95% CI [2.5-9.6]). Both peritumoral hypointensity on HBP and multifocality showed very high meta-analytic pooled specificities for diagnosing MVI (91.1% [85.4-94.8%] and 93.3% [74.5-98.5%], respectively).

Conclusions: Seven MRI features including larger tumor size, rim arterial enhancement, arterial peritumoral enhancement, peritumoral hypointensity on HBP, nonsmooth margin, multifocality, and hypointensity on T1WI were significant predictors for MVI of HCC. These MRI features predictive of MVI can be useful in the management of HCC.
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http://dx.doi.org/10.1159/000513704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077694PMC
April 2021

Combined computed tomography and magnetic resonance imaging improves diagnosis of hepatocellular carcinoma ≤ 3.0 cm.

Hepatol Int 2021 Jun 6;15(3):676-684. Epub 2021 May 6.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

Background/purpose: Imaging diagnosis of hepatocellular carcinoma (HCC) is important, but the diagnostic performance of combined computed tomography (CT) and magnetic resonance imaging (MRI) using the Liver Imaging Reporting and Data System (LI-RADS) v2018 is not fully understood. We evaluated the clinical usefulness of combined CT and MRI for diagnosing HCC ≤ 3.0 cm using LI-RADS.

Methods: In 222 patients at risk of HCC who underwent both contrast-enhanced dynamic CT and gadoxetate disodium-enhanced MRI in 2017, 291 hepatic nodules ≤ 3.0 cm were retrospectively analyzed. Two radiologists performed image analysis and assigned a LI-RADS category to each nodule. The diagnostic performance for HCC was evaluated for CT, ordinary-MRI (washout confined to portal venous-phase), and modified-MRI (washout extended to hepatobiliary phase), and sensitivity and specificity were calculated for each modality. Generalized estimating equations were used to compare the diagnostic performance for HCC between combined CT and ordinary-MRI, combined CT and modified-MRI, and CT or MRI alone. p < 0.0062 (0.05/8) was considered statistically significant following Bonferroni correction for multiple comparisons.

Results: In 291 nodules, the sensitivity and specificity of CT, ordinary-MRI, and modified-MRI were 70.2% and 92.8%, 72.6% and 96.4%, and 84.6% and 88.0%, respectively. Compared with CT or MRI alone, both combined CT and ordinary-MRI (sensitivity, 83.7%; specificity, 95.2%) and combined CT and modified-MRI (sensitivity, 88.9%; specificity, 89.2%) showed significantly higher sensitivity (p ≤ 0.006), without a significant decrease in specificity (p ≥ 0.314).

Conclusions: Compared with CT or MRI alone, combined CT and MRI can increase sensitivity for diagnosing HCC ≤ 3.0 cm, without a significant decrease in specificity.
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http://dx.doi.org/10.1007/s12072-021-10190-xDOI Listing
June 2021

Correction to: Inter-reader reliability of CT Liver Imaging Reporting and Data System according to imaging analysis methodology: a systematic review and meta-analysis.

Eur Radiol 2021 Nov;31(11):8820-8821

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

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http://dx.doi.org/10.1007/s00330-021-07949-zDOI Listing
November 2021

Preoperative prediction of postsurgical outcomes in mass-forming intrahepatic cholangiocarcinoma based on clinical, radiologic, and radiomics features.

Eur Radiol 2021 Nov 23;31(11):8638-8648. Epub 2021 Apr 23.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

Objectives: Current prognostic systems for intrahepatic cholangiocarcinoma (IHCC) rely on surgical pathology data and are not applicable to a preoperative setting. We aimed to develop and validate preoperative models to predict postsurgical outcomes in mass-forming IHCC patients based on clinical, radiologic, and radiomics features.

Methods: This multicenter retrospective cohort study included patients who underwent curative-intent resection for mass-forming IHCC. In the development cohort (single institution data), three preoperative multivariable Cox models for predicting recurrence-free survival (RFS) were constructed, including the clinical-radiologic, radiomics, and clinical-radiologic-radiomics (CRR) models based on clinical and CT findings, CT-radiomics features, and a combination of both, respectively. Model performance was evaluated in the test cohort (data from five institutions) using Harrell's C-index and compared with postoperative prognostic systems.

Results: A total of 345 patients (233, development cohort; 112, test cohort) were evaluated. The clinical-radiologic model included five independent CT predictors (infiltrative contour, multiplicity, periductal infiltration, extrahepatic organ invasion, and suspicious metastatic lymph node) and showed similar performance in predicting RFS to the radiomics model (C-index, 0.65 vs. 0.68; p = 0.43 in the test cohort). The CRR model showed significantly improved performance (C-index, 0.71; p = 0.01) than the clinical-radiologic model and demonstrated similar performance to the postoperative prognostic systems in predicting RFS (C-index, 0.71-0.73 vs. 0.70-0.73; p ≥ 0.40) and overall survival (C-index, 0.68-0.71 vs. 0.64-0.74; p ≥ 0.27) in the test cohort.

Conclusions: A model integrating clinical, CT, and radiomics information may be useful for the preoperative assessment of postsurgical outcomes in patients with mass-forming IHCC.

Key Points: • The radiomics analysis had incremental value in predicting recurrence-free survival of patients with intrahepatic mass-forming cholangiocarcinoma. • The clinical-radiologic-radiomics model demonstrated similar performance to the postoperatively available prognostic systems (including 8th AJCC system) in predicting recurrence-free survival and overall survival. • The clinical-radiologic-radiomics model may be useful for the preoperative assessment of postsurgical outcomes in patients with mass-forming intrahepatic cholangiocarcinoma.
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http://dx.doi.org/10.1007/s00330-021-07926-6DOI Listing
November 2021

Inter-reader reliability of CT Liver Imaging Reporting and Data System according to imaging analysis methodology: a systematic review and meta-analysis.

Eur Radiol 2021 Sep 13;31(9):6856-6867. Epub 2021 Mar 13.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

Objectives: To establish inter-reader reliability of CT Liver Imaging Reporting and Data System (LI-RADS) and explore factors that affect it.

Methods: MEDLINE and EMBASE databases were searched from January 2014 to March 2020 to identify original articles reporting the inter-reader reliability of CT LI-RADS. The imaging analysis methodology of each study was identified, and pooled intraclass correlation coefficient (ICC) or kappa values (κ) were calculated for lesion size, major features (arterial-phase hyperenhancement [APHE], nonperipheral washout [WO], and enhancing capsule [EC]), and LI-RADS categorization (LR) using random-effects models. Subgroup analyses of pooled κ were performed for the number of readers, average reader experience, differences in reader experience, and LI-RADS version.

Results: In the 12 included studies, the pooled ICC or κ of lesion size, APHE, WO, EC, and LR were 0.99 (0.96-1.00), 0.69 (0.58-0.81), 0.67 (0.53-0.82), 0.65 (0.54-0.76), and 0.70 (0.59-0.82), respectively. The experience and number of readers varied: studies using readers with ≥ 10 years of experience showed significantly higher κ for LR (0.82 vs. 0.45, p = 0.01) than those with < 10 years of reader experience. Studies with multiple readers including inexperienced readers showed significantly lower κ for APHE (0.55 vs. 0.76, p = 0.04) and LR (0.45 vs. 0.79, p = 0.02) than those with all experienced readers.

Conclusions: CT LI-RADS showed substantial inter-reader reliability for major features and LR. Inter-reader reliability differed significantly according to average reader experience and differences in reader experience. Reported results for inter-reader reliability of CT LI-RADS should be understood with consideration of the imaging analysis methodology.

Key Points: • The CT Liver Imaging Reporting and Data System (LI-RADS) provides substantial inter-reader reliability for three major features and category assignment. • The imaging analysis methodology varied across studies. • The inter-reader reliability of CT LI-RADS differed significantly according to the average reader experience and the difference in reader experience.
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http://dx.doi.org/10.1007/s00330-021-07815-yDOI Listing
September 2021

Surveillance failure in ultrasound for hepatocellular carcinoma: a systematic review and meta-analysis.

Gut 2021 Mar 1. Epub 2021 Mar 1.

Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.

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http://dx.doi.org/10.1136/gutjnl-2020-323615DOI Listing
March 2021

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis.

J Magn Reson Imaging 2021 07 11;54(1):103-112. Epub 2021 Feb 11.

Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Background: The Prostate Imaging Reporting and Data System (PI-RADS) was introduced in 2012 and updated to version 2.1 (v2.1) in early 2019 to improve diagnostic performance and interreader reliability.

Purpose: To evaluate the diagnostic performance of PI-RADS v2.1 in comparison with v2.

Methods: A systematic review and meta-analysis of the literature was performed using MEDLINE, EMBASE, and Cochrane databases to identify studies evaluating the diagnostic performance of PI-RADS v2.1 for diagnosing clinically significant prostate cancer (csPCa).

Study Type: Systematic review and meta-analysis.

Subject: One thousand two hundred forty-eight patients with 1406 lesions from 10 eligible articles.

Field Strength/sequence: Conventional MR sequences at 1.5 T and 3 T.

Assessment: Two reviewers independently identified and reviewed the original articles reporting diagnostic performance of PI-RADS v2.1.

Statistical Tests: Meta-analytic summary sensitivity and specificity were calculated using a bivariate random effects model. Meta-analytic sensitivity and specificity between PI-RADS v2 and v2.1 were compared.

Results: The pooled sensitivity and specificity of PI-RADS v2.1 were 87% (95% confidence intervals, 82-91%) and 74% (63-82%), respectively. In five studies available for a head-to-head comparison between PI-RADS v2.1 and v2, there were no significant differences in either sensitivity (90% [86-94%] vs. 88% [83-93%], respectively) or specificity (76% [59-93%] vs. 61% [39-83%], respectively; P = 0.37). The sensitivity and specificity were 81% (73-87%) and 82% (68-91%), respectively, for a PI-RADS score cutoff of ≥4, and 94% (88-97%) and 56% (35-97%) for ≥3. Regarding the zonal location, the sensitivity and specificity for the transitional zone only were 90% (84-96%) and 76% (62-90%) respectively, whereas for the whole gland they were 85% (79-91%) and 71% (57-85%).

Data Conclusion: PI-RADS v2.1 demonstrated good overall performance for the diagnosis of csPCa. PI-RADS v2.1 tended to show higher specificity than v2, but the difference lacked statistical significance.

Level Of Evidence: 3 TECHNICAL EFFICACY STAGE: 3.
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http://dx.doi.org/10.1002/jmri.27546DOI Listing
July 2021

Combined Hepatocellular-Cholangiocarcinoma: Magnetic Resonance Imaging Features and Prognosis According to Risk Factors for Hepatocellular Carcinoma.

J Magn Reson Imaging 2021 06 9;53(6):1803-1812. Epub 2021 Feb 9.

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

Background: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) can develop in patients with and without risk factors for hepatocellular carcinoma (HCC).

Purpose: To compare the clinical and magnetic resonance imaging (MRI) characteristics of cHCC-CCA in patients with and without risk factors for HCC, and to assess the influence of risk factors on patient prognosis.

Study Type: Retrospective.

Population: A total of 152 patients with surgically confirmed cHCC-CCA.

Field Strength/sequence: 1.5-T and 3-T/T1-weighted dual gradient-echo in- and opposed-phase, T2-weighted turbo-spin-echo, diffusion-weighted single-shot spin-echo echo-planar, and T1-weighted three-dimensional gradient-echo contrast-enhanced sequences.

Assessment: MRI features according to the Liver Imaging Reporting and Data System (LI-RADS) and pathologic findings based on revised classification were compared between patients with and without risk factors for HCC. Overall survival (OS) and recurrence-free survival (RFS) were also compared between the two groups, and factors associated with survival were evaluated.

Statistical Tests: The clinico-pathologic and MRI features of the two groups were compared using Student's t-tests, Mann-Whitney U-tests, and chi-square tests. OS and RFS were evaluated by the Kaplan-Meier method, and factors associated with survival were evaluated by Cox proportional hazard model.

Results: cHCC-CCA in patients with risk factors were more frequently classified as LI-RADS category 4 or 5 (LR-4/5; probably or definitely HCC) (48.7%), whereas those without risk factors were more frequently classified as category M (LR-M; probably malignant, not specific for HCC) (63.6%). RFS and OS did not differ significantly according to risk factors (P = 0.63 and 0.83). Multivariable analysis showed that pathologic tumor type (hazard ratio 2.02; P < 0.05) and LI-RADS category (hazard ratio 2.19; P < 0.05) were significantly associated with RFS and OS, respectively.

Data Conclusion: Although MRI features of cHCC-CCA differed significantly between patients with and without risk factors for HCC, postsurgical prognosis did not. LI-RADS category and pathologic tumor type were independently correlated with postsurgical prognosis in patients with cHCC-CCA.

Level Of Evidence: 3 TECHNICAL EFFICACY STAGE: 2.
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http://dx.doi.org/10.1002/jmri.27528DOI Listing
June 2021

Interreader Reliability of Liver Imaging Reporting and Data System Treatment Response: A Systematic Review and Meta-Analysis.

Diagnostics (Basel) 2021 Feb 4;11(2). Epub 2021 Feb 4.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.

Background: For a proper management strategy in patients with locoregionally treated hepatocellular carcinoma (HCC), it is essential that the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR) has high interreader reliability. We aimed to systematically evaluate the interreader reliability of LR-TR and sources of any study heterogeneity.

Methods: Original studies reporting the interreader reliability of LR-TR were identified in MEDLINE and EMBASE up to 20 September 2020. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random effects model. Subgroup analyses were performed according to imaging modality (magnetic resonance imaging (MRI) or computed tomography (CT)). Meta-regression analyses were performed to explore study heterogeneity.

Results: Eight studies with 851 HCCs were finally included. Pooled κ was 0.70 (95% CI, 0.58-0.82) for CT/MRI LR-TR, and those of MRI and CT were 0.71 (95% CI, 0.53-0.89) and 0.71 (95% CI, 0.65-0.78), respectively. Study design ( < 0.001) and type of treatment ( = 0.02) were significantly associated with substantial study heterogeneity.

Conclusion: LR-TR showed substantial interreader reliability regardless of the imaging modality. Because of substantial study heterogeneity, which was significantly associated with study design and type of treatment, published values for the interreader reliability of LR-TR should be interpreted with care.
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http://dx.doi.org/10.3390/diagnostics11020237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913820PMC
February 2021

Diagnostic performance of ultrasonography-guided core-needle biopsy according to MRI LI-RADS diagnostic categories.

Ultrasonography 2021 Jul 3;40(3):387-397. Epub 2020 Nov 3.

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

Purpose: According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories.

Methods: A total of 145 High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results.

Results: After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies.

Conclusion: In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.
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http://dx.doi.org/10.14366/usg.20110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217794PMC
July 2021

Diagnostic performance of Liver Imaging Reporting and Data System treatment response algorithm: a systematic review and meta-analysis.

Eur Radiol 2021 Jul 6;31(7):4785-4793. Epub 2021 Jan 6.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.

Objective: To systematically determine the accuracy of Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm for diagnosing the viability of hepatocellular carcinoma (HCC) treated with locoregional therapy (LRT).

Methods: Original studies reporting the diagnostic accuracy of LR-TR algorithm on dynamic contrast-enhanced computed tomography or magnetic resonance imaging (MRI) were identified in MEDLINE and EMBASE up to June 1, 2020. The meta-analytic summary sensitivity and specificity of LR-TR algorithm were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression analysis were performed to explore study heterogeneity.

Results: We found six studies reporting the accuracy of LR-TR viable category (601 observations in 453 patients). The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% confidence interval [CI], 39-81%; I = 88%) and 96% (95% CI, 91-99%; I = 76%), respectively. The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55-84%; I = 89%) and 87% (95% CI, 73-94% I = 80%), respectively. Studies which used only MRI showed a trend towards higher sensitivity (71% [95% CI, 46-88%]) with a comparable specificity (95% [95% CI, 86-99%]) of LR-TR viable category compared to the whole group. The type of reference standard and study design were significantly associated with study heterogeneity (p ≤ 0.01).

Conclusions: The LR-TR viable category had high specificity but suboptimal sensitivity for diagnosing the viability of HCC after LRT. Substantial study heterogeneity was noted, and it was significantly associated with the type of reference standard and study design.

Key Points: • The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% CI, 39-81%) and 96% (95% CI, 91-99%), respectively. • The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55-84%) and 87% (95% CI, 73-94%), respectively. • The type of reference standard and study design were the factors significantly influencing study heterogeneity (p ≤ 0.01).
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http://dx.doi.org/10.1007/s00330-020-07464-7DOI Listing
July 2021

Individual variations lead to universal and cross-species patterns of social behavior.

Proc Natl Acad Sci U S A 2020 12 30;117(50):31754-31759. Epub 2020 Nov 30.

Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL 61801;

The duration of interaction events in a society is a fundamental measure of its collective nature and potentially reflects variability in individual behavior. Here we performed a high-throughput measurement of trophallaxis and face-to-face event durations experienced by a colony of honeybees over their entire lifetimes. The interaction time distribution is heavy-tailed, as previously reported for human face-to-face interactions. We developed a theory of pair interactions that takes into account individual variability and predicts the scaling behavior for both bee and extant human datasets. The individual variability of worker honeybees was nonzero but less than that of humans, possibly reflecting their greater genetic relatedness. Our work shows how individual differences can lead to universal patterns of behavior that transcend species and specific mechanisms for social interactions.
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http://dx.doi.org/10.1073/pnas.2002013117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749354PMC
December 2020

Accuracy of contrast-enhanced ultrasound liver imaging reporting and data system: a systematic review and meta-analysis.

Hepatol Int 2020 Dec 10;14(6):1104-1113. Epub 2020 Nov 10.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

Background And Aim: After the introduction of the contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS), several studies have reported on its performance, but the reported data vary considerably. Therefore, we performed a systematic review and meta-analysis to determine the diagnostic performance of CEUS LI-RADS in patients at risk for hepatocellular carcinoma (HCC) and investigate the causes of study heterogeneity.

Methods: Original studies published until May 30, 2020, investigating the diagnostic performance of CEUS LI-RADS were identified in the MEDLINE, EMBASE, and Cochrane library databases. Study quality was assessed using the QUADAS-2 tool. Meta-analytic summary sensitivity and specificity for the diagnosis of HCC were calculated using a bivariate random-effects model. Meta-regression analysis was performed to explore the causes of study heterogeneity.

Results: Of the 105 articles screened, eight studies were finally analyzed (5428 hepatic observations). The summary sensitivity and specificity of CEUS LI-RADS category 5 (LR-5) for diagnosing HCC were 73% [95% confidence interval (CI) 65-79%; I = 93%] and 95% (95% CI 91-97%; I = 89%), respectively. Substantial study heterogeneity was noted in both sensitivity and specificity. Study heterogeneity was significantly associated with the proportion of cases of HCC and the type of reference standard (p ≤ 0.05).

Conclusion: CEUS LI-RADS had high pooled specificity for diagnosing HCC but suboptimal pooled sensitivity. Substantial study heterogeneity was found, which was significantly associated with the proportion of cases of HCC and the type of reference standard.
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http://dx.doi.org/10.1007/s12072-020-10102-5DOI Listing
December 2020
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