Publications by authors named "Seung Baek Hong"

20 Publications

  • Page 1 of 1

Validation of functional liver imaging scores (FLIS) derived from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Child-Pugh score and FLIS.

Eur Radiol 2021 Apr 21. Epub 2021 Apr 21.

Department of Radiology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.

Objectives: To validate the functional liver imaging score (FLIS) for prediction of hepatic function in gadoxetic acid-enhanced MRI.

Methods: We retrospectively identified 134 patients (88 men, 46 women; mean age, 58.8 years) between January 2015 and December 2018 with the following inclusion criteria: patients diagnosed with liver cirrhosis or chronic liver disease (CLD) who underwent gadoxetic acid-enhanced MRI. Three parameters on hepatobiliary phase images were evaluated for FLIS: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified as CLD (n = 11), Child-Pugh (CP) class A (n = 87), CP B (n = 22), or CP C (n = 14). We assessed the correlation between CP score and both FLIS and its components using Spearman rank correlation. Receiver operating characteristic (ROC) curve analysis was performed to demonstrate the cutoff value of FLIS for differentiating between CP classes. The associations between patient characteristics, serum markers, FLIS, and hepatic decompensation were evaluated with Cox proportional hazard models.

Results: FLIS and three FLIS parameters showed strong to very strong correlation with CP score (r = -0.60 to 0.82). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of CP class A or CLD (sensitivity, 83.7%; specificity, 94.4%; area under the curve [AUC], 0.93). FLIS < 5 was independently associated with the development of first hepatic decompensation in patients with CP A (HR, 50.0; 95% confidence interval, 6.2, 400.4).

Conclusion: FLIS showed a strong correlation with hepatic function and can stratify the CP class. In addition, FLIS can help prediction for the development of first decompensation.

Key Points: • Functional liver imaging scores (FLIS) and its three parameters, derived from hepatobiliary phase image, have strong to very strong correlations with Child-Pugh (CP) scores. • FLIS can stratify patients with chronic liver disease or liver cirrhosis according to CP classification. • Low FLIS is an independent predictor for first hepatic decompensation in patients with CP class A.
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http://dx.doi.org/10.1007/s00330-021-07955-1DOI Listing
April 2021

Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm.

Yeungnam Univ J Med 2021 Apr 7. Epub 2021 Apr 7.

Department of Surgery, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.
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http://dx.doi.org/10.12701/yujm.2021.00969DOI Listing
April 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

Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication.

Jpn J Radiol 2021 Apr 11;39(4):349-356. Epub 2020 Nov 11.

Department of Radiology, Biomedical Research Institute, Pusan National University Yansan Hospital, and Pusan National University school of Medicine, Yangsan, Korea.

Purpose: To compare the content and communication between the radiologist and the clinicians for treatment planning of structured reports (SRs) and narrative reports (NRs) for reporting CT/MRI findings in patients with perihilar cholangiocarcinoma.

Materials And Method: This retrospective study included 54 patients with perihilar cholangiocarcinoma who underwent CT/MRI before ERCP or surgery. For all patients, we generated both NRs and SRs for perihilar cholangiocarcinoma and compared the number of key features between NRs and SRs. In addition, three clinicians performed a questionnaire evaluation that included three questions regarding assessment of the sufficiency of information for surgical or procedural planning, the effort required for information extraction, and the report quality rated on a Likert scale.

Results: SRs included significantly more predefined key features (6.89 ± 0.31) than NRs (5.87 ± 0.70) (p < 0.001). SRs provided greater sufficiency of information for clinical planning than NRs (89.9% vs. 18.5% of the cases, respectively; p < 0.001). Extraction of information was easier from SRs than NRs (94.4% vs. 9.3%, respectively) (p < 0.001). SRs received a higher overall report quality rating (5.96 ± 0.19) than NRs (4.31 ± 0.77) (p < 0.001).

Conclusions: SRs of CT/MRI findings for hilar cholangiocarcinoma can reveal more predefined key features, provide more sufficiency of information, and yield higher satisfaction levels, in comparison with NRs.
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http://dx.doi.org/10.1007/s11604-020-01068-3DOI Listing
April 2021

CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis.

Eur Radiol 2021 May 30;31(5):3383-3393. Epub 2020 Oct 30.

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.

Objectives: We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods: Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until February 24, 2020. The identified studies were divided into two groups based on the criteria of R0 resectable tumor (ordinary criterion: resectable PDAC alone; extended criterion: resectable and borderline resectable PDAC). The meta-analytic summary of the sensitivity and specificity for each criterion was estimated separately using a bivariate random-effect model. Summary results of the two criteria were compared using a joint-model bivariate meta-regression.

Results: Of 739 studies initially searched, 6 studies (6 with ordinary criterion and 5 with extended criterion) were included for analysis. The meta-analytic summary of sensitivity and specificity was 45% (95% confidence interval [CI], 19-73%; I = 88.3%) and 85% (95% CI, 65-94%; I = 60.5%) for the ordinary criterion, and 81% (95% CI, 71-87%; I = 0.0%) and 42% (95% CI, 28-57%; I = 6.2%) for the extended criterion, respectively. The diagnostic accuracy significantly differed between the two criteria (p = 0.02).

Conclusions: For determining resectability on CT, the ordinary criterion might be highly specific but insensitive for predicting R0 resection, whereas the extended criterion increased sensitivity but would decrease specificity. Further investigations using quantitative parameters may improve the identification of R0 resection.

Key Points: • CT-determined resectability of PDAC after neoadjuvant treatment using the ordinary criterion shows low sensitivity and high specificity in predicting R0 resection. • With the extended criterion, CT-determined resectability shows higher sensitivity but lower specificity than with the ordinary criterion. • CT-determined resectability with both criteria achieved suboptimal diagnostic performances, suggesting that care should be taken while selecting surgical candidates and when determining the surgical extent after neoadjuvant treatment in patients with PDAC.
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http://dx.doi.org/10.1007/s00330-020-07433-0DOI Listing
May 2021

Subcentimeter hepatocellular carcinoma in treatment-naïve patients: noninvasive diagnostic criteria and tumor staging on gadoxetic acid-enhanced MRI.

Eur Radiol 2021 Apr 12;31(4):2321-2331. Epub 2020 Oct 12.

Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Objective: It is controversial to adopt non-invasive diagnostic criteria of hepatocellular carcinoma (HCC) in subcentimeter lesions. This study was aimed to define the optimal noninvasive diagnostic criteria of subcentimeter HCC and to evaluate the effect on tumor staging.

Methods: We included 110 treatment-naïve patients at risk of HCC and eligible for curative treatment who had subcentimeter lesions (n = 136) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) performed between January 2013 and December 2013. Modified diagnostic criteria for subcentimeter HCC were developed using logistic regression analysis. Accuracies of MR staging with and without using the modified criteria were compared by generalized estimating equation test using pathologic staging as reference standards. Subgroup analysis was performed for patients with co-existing HCC ≥ 1 cm (co-HCC).

Results: The modified criteria (presence of co-HCC, arterial phase hyperenhancement, and hypointensity on transitional phase [TP]) showed 61.5% (95% CI, 41.6-78.2) of sensitivity and 98.2% (95% CI, 93.0-99.5) of specificity. Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001). Fifty percent of subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001). In the subgroup with co-HCCs, the accuracy of MR staging with subcentimeter HCCs was improved from 69.0% to 92.8% (p = 0.001).

Conclusions: Including subcentimeter HCCs based on the modified diagnostic criteria (co-existing HCC ≥ 1 cm, arterial phase hyperenhancement, and hypointensity on TP) improved MR staging accuracy.

Key Points: • Fifty percent of non-benign appearing subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001). • Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001).
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http://dx.doi.org/10.1007/s00330-020-07329-zDOI Listing
April 2021

First-line chemotherapy in very elderly patients with metastatic pancreatic cancer: Gemcitabine monotherapy combination chemotherapy.

World J Clin Cases 2020 Sep;8(18):4022-4033

Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea.

Background: Combination chemotherapy (gemcitabine plus nab-paclitaxel and FOLFIRINOX) is widely used as the standard first-line treatment for pancreatic cancer. Considering the severe toxicities of combination chemotherapy, gemcitabine monotherapy (G mono) could be used as a first-line treatment in very elderly patients or those with a low Eastern Cooperative Oncology Group status. However, reports on the efficacy of G mono in patients older than 75 years are limited.

Aim: To evaluate the efficacy of G mono and combination chemotherapy by comparing their clinical outcomes in very elderly patients with pancreatic cancer.

Methods: We retrospectively analyzed 104 older patients with pancreatic cancer who underwent chemotherapy with G mono ( = 45) or combination therapy ( = 59) as a first-line treatment between 2011 and 2019. All patients were histologically diagnosed with ductal adenocarcinoma. Primary outcomes were progression-free survival and overall survival. We also analyzed subgroups according to age [65-74 years (elderly) and ≥ 75 years (very elderly)]. Propensity score matching was performed to compare the outcomes between the two chemotherapy groups.

Results: The baseline characteristics were significantly different between the two chemotherapy groups, especially regarding age, ratio of multiple metastases, tumor burden, and Eastern Cooperative Oncology Group performance status. After propensity score matching, the baseline characteristics were not significantly different between the chemotherapy groups in elderly and very elderly patients. In the elderly patients, the median progression-free survival (62 d 206 d, = 0.000) and overall survival (102 d 302 d, = 0.000) were longer in the combination chemotherapy group. However, in the very elderly patients, the median progression-free survival (147 d and 174 d, respectively, = 0.796) and overall survival (227 d and 211 d, respectively, = 0.739) were comparable between the G mono and combination chemotherapy groups. Adverse events occurred more frequently in the combination chemotherapy group than in the G mono group, especially thromboembolism (G mono nab-paclitaxel FOLFIRINOX; 8.9% 5.9% 28%, = 0.041), neutropenia (40.0% 76.5% 84.0%, = 0.000), and neuropathy (0% 61.8% 28.0%, = 0.006).

Conclusion: In elderly patients, combination therapy is more effective than G mono. However, G mono is superior for the management of metastatic pancreatic cancer in very elderly patients.
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http://dx.doi.org/10.12998/wjcc.v8.i18.4022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520790PMC
September 2020

Comparison of gemcitabine plus nab-paclitaxel and FOLFIRINOX in metastatic pancreatic cancer.

World J Clin Cases 2020 Sep;8(17):3718-3729

Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea.

Background: Gemcitabine plus nab-paclitaxel (GA) and modified FOLFIRINOX (FFX) have been widely used as standard first-line treatment in pancreatic cancer. However, it is unclear which regimen is more efficacious.

Aim: To evaluate a retrospective analysis comparing the efficacy and safety of FFX and GA as first-line chemotherapeutic regimens in patients with metastatic pancreatic cancer.

Methods: We retrospectively analyzed and compared outcomes in 101 patients who presented with pancreatic cancer and were treated with either GA ( = 54) or FFX ( = 47). Moreover, we performed subgroup analysis based on the neutrophil/lymphocyte ratio (NLR) and Eastern Cooperative Oncology Group (ECOG) performance status.

Results: There were no significant differences between two groups in baseline characteristics, except for the ECOG performance status. The median progression-free survival (PFS) (6.43 mo 4.90 mo, = 0.058) was comparable between two groups; however, median overall survival (OS) (10.17 mo 6.93 mo, = 0.008) was longer in patients who received GA regimen. In patients with ECOG 0 (PFS: 8.93 mo 5.43 mo, = 0.002; OS: 16.10 mo 6.97 mo, = 0.000) and those with NLR < 3 (PFS: 8.10 mo 6.57 mo, = 0.008; OS: 12.87 mo 9.93 mo, = 0.002), GA regimen showed higher efficacy.

Conclusion: GA regimen may be recommended to the patients with NLR < 3 or ECOG 0 status although GA and FFX showed comparable efficacy outcomes in patients with metastatic pancreatic cancer.
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http://dx.doi.org/10.12998/wjcc.v8.i17.3718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479547PMC
September 2020

Vesical Imaging-Reporting and Data System for Multiparametric MRI to Predict the Presence of Muscle Invasion for Bladder Cancer.

J Magn Reson Imaging 2020 10 27;52(4):1249-1256. Epub 2020 Mar 27.

Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Busan, Korea.

Background: The Vesical Imaging-Reporting and Data System (VI-RADS) is a newly developed system of bladder cancer staging with multiparametric MRI (mpMRI), which can be used to predict the presence of muscle invasion for bladder cancer.

Purpose: To evaluate the accuracy of three mpMRI series (T WI, diffusion-weighted imaging [DWI], and dynamic contrast-enhanced image [DCEI]) and VI-RADS for diagnosing the muscle invasive bladder cancer (MIBC).

Study Type: Retrospective.

Population: In all, 66 pathologically proven bladder cancers in 32 patients.

Field Strength/sequence: Before the diagnostic MRI with an intramuscular antispasmodic agent, optimal bladder distension was confirmed. 3.0T MRI with T WI, DWI, and DCEI.

Assessment: Three reviewers independently assessed and scored the bladder cancers in T WI, DWI, and DCEI using a five-point score system. Based on the scores in the three sequences, reviewers scored each bladder cancer with reference to VI-RADS categories. We evaluated the diagnostic performance of each of three mpMRI sequences and the final VI-RADS categorization for diagnosing MIBC.

Statistical Tests: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) of each of three sequences separately and VI-RADS categorization for diagnosing the MIBC.

Results: The diagnostic performances of each of the three mpMRI series and VI-RADS for diagnosing MIBC were excellent. Especially using the optimal cutoff score >3 for predicting MIBC on DWI, DCEI, and VI-RADS, the sensitivity, specificity, PPV, NPV, and AUC values were 90% (95% confidence interval [CI]: 0.56, 1.00), 100% (95% CI: 0.94, 1.00), 100% (95% CI: 0.66. 1.00), 98.3% (95% CI: 0.91, 1.00), and 0.95, respectively. DATA CONCLUSION: mpMRI based on VI-RADS can stratify patients with bladder cancer according to the presence of muscle invasion.

Level Of Evidence: 3.

Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2020;52:1249-1256.
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http://dx.doi.org/10.1002/jmri.27141DOI Listing
October 2020

Is it worth carrying out ultrasound-magnetic resonance imaging fusion targeted biopsy on Prostate Imaging Reporting and Data System score 3 prostate lesions?

Int J Urol 2020 May 18;27(5):431-438. Epub 2020 Mar 18.

Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Objectives: To evaluate the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System 3 prostate lesions.

Methods: We identified 227 patients with prostate-specific antigen levels ≥4 ng/mL who underwent concurrent transrectal ultrasound-guided systemic biopsy and fusion biopsy. Suspicious prostatic lesions were assessed in accordance with Prostate Imaging Reporting and Data System version 2.0. We compared ultrasound-magnetic resonance imaging fusion targeted biopsy and ultrasound-guided biopsy cancer detection rates in Prostate Imaging Reporting and Data System 3 lesions with those in other Prostate Imaging Reporting and Data System score lesions. In Prostate Imaging Reporting and Data System 3 patients, we identified clinically significant prostate cancer risk factors by logistic regression analysis.

Results: In total, 2770 transrectal ultrasound-guided and 867 fusion biopsy cores were obtained; where 332 (12.0%) and 194 (22.4%) cores were prostate cancer-positive, respectively (P < 0.001). The fusion biopsy cancer detection rate (8.0%) in Prostate Imaging Reporting and Data System 3 lesions was similar to that in Prostate Imaging Reporting and Data System 1-2 lesions, but was lower than that of Prostate Imaging Reporting and Data System 4 (30.0%; P < 0.001) and 5 lesions (65.2%; P < 0.001), and ultrasound-guided biopsy (12.0%; P = 0.023). For clinically significant prostate cancer detection, fusion biopsy in Prostate Imaging Reporting and Data System 3 lesions was inferior to that in Prostate Imaging Reporting and Data System 4 and 5 lesions, and non-superior to ultrasound-guided biopsy. Cancer detection rate trends were similar in biopsy-naïve patients. In Prostate Imaging Reporting and Data System 3 patients, prostate-specific antigen density was the only significant predictor of clinically significant prostate cancer.

Conclusions: The present findings do not support the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System 3 lesions. Thus, we recommend the use of transrectal ultrasound-guided systemic biopsy for patients with Prostate Imaging Reporting and Data System 3 index lesions.
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http://dx.doi.org/10.1111/iju.14213DOI Listing
May 2020

A ruptured jejunal gastrointestinal stromal tumor with hemoperitoneum mimicking ovarian carcinoma.

Int J Clin Exp Pathol 2020 1;13(1):49-53. Epub 2020 Jan 1.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pusan National University Hospital and Pusan National University College of Medicine Busan, Republic of Korea.

Background: Gastrointestinal stromal tumor (GIST) of the small bowel is a rare malignancy and accounts for only 0.1-3% of all gastrointestinal neoplasms. GISTs may mimic gynecologic tumors. The authors present an unusual case of ruptured jejunal GIST with hemoperitoneum mimicking ovarian carcinoma.

Case Presentation: A 57-year-old postmenopausal woman presented with progressive, generalized low abdominal pain for 3 months. Computed tomography (CT) imaging depicted a 9.6 cm-sized, complex and solid mass on the left pelvic cavity and a 3.7 cm-sized heterogeneous, enhancing mass on the right adnexa, suspicious for ovarian cancer accompanied by hemoperitoneum. There was no active bleeding. Laboratory examination revealed a low level of serum hemoglobin (6.7 g/dL), and a raised serum level of CA-125 (107.0 U/mL). Based on CT imaging findings and an elevated serum level of CA-125, bilateral ovarian cancer was suspected. The patient underwent exploratory laparotomy, and frozen section of the excised mass indicated malignancy originating from the small bowel jejunum. Consequently, small bowel segmental resection with mesenteric resection was done, and a debulking operation including hysterectomy, BSO, BPLD, omentectomy, and excision of multiple metastatic masses in the peritoneum was performed. Subsequent histopathologic examination confirmed the final diagnosis of high risk GISTs of the primary small bowel jejunum. The patient's postoperative course was uneventful, and adjuvant Imatinib was administered.

Conclusion: The authors report an unusual case of ruptured jejunal GIST with hemoperitoneum mimicking ovarian carcinoma. Therefore, GIST, in addition to ovarian cancer, should be considered in patients with an increased serum level of CA-125 and an abdominopelvic mass.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013367PMC
January 2020

CT diagnosis of non-traumatic gastrointestinal perforation: an emphasis on the causes.

Jpn J Radiol 2020 Feb 17;38(2):101-111. Epub 2019 Dec 17.

Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, Korea.

Gastrointestinal tract (GI) perforations can occur due to various causes such as trauma, iatrogenic factor, infectious condition, peptic ulcer, inflammatory disease, or a neoplasm. Because GI perforations represent an emergency and life-threatening condition, prompt diagnosis and surgical treatment are required in most cases. However, according to the underlying causes of GI perforations, additional treatment strategies may be needed. Adjuvant chemotherapy or immunotherapy may be required in various GI neoplasms such as adenocarcinoma, lymphoma or gastrointestinal stromal tumor. Inflammatory bowel disease is a chronic disease repeating cycle of intermittent, thus appropriate medical treatment and periodic follow-up are also required. Moreover, vascular intervention may have a role in some cases of mesenteric ischemia associated with mesenteric artery occlusion. Recently, computed tomography (CT) has been the first choice for patients with suspected GI perforations, because CT plays an important role in the accurate assessment of the perforation site, the pathology causing the perforation and the ensuing complications. This review will illustrate characteristic CT findings that differentiate underlying pathologies causing GI perforations to help clinicians decision-making regarding an optimal treatment plan.
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http://dx.doi.org/10.1007/s11604-019-00910-7DOI Listing
February 2020

Meta-analysis of MRI for the diagnosis of liver metastasis in patients with pancreatic adenocarcinoma.

J Magn Reson Imaging 2020 06 30;51(6):1737-1744. Epub 2019 Oct 30.

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

Background: Determining if a given patient with primary pancreatic adenocarcinoma (PDA) has hepatic metastasis is important for treatment planning. Several previous studies reported on the diagnostic performance of MRI for liver metastasis in patients with PDA. But the reported data are quite variable.

Purpose: To systematically determine the diagnostic performance of MRI for liver metastasis in patients with PDA, including comparing it with computed tomography (CT).

Study Type: Systemic review and meta-analysis.

Subjects: In all, 457 patients from five eligible articles.

Field Strength/sequence: Conventional MR sequences with or without contrast enhancement at 1.5T and 3T.

Assessment: Two reviewers independently performed the data extraction. The reviewers identified and reviewed the original articles reporting the diagnostic performance of MRI for liver metastases in patients with PDA, including those articles making comparisons with CT.

Statistical Tests: Meta-analytic summary sensitivity and specificity were calculated on a per-patient basis using a bivariate random effects model. We compared the meta-analytic summary sensitivity and specificity between MRI and CT.

Results: The meta-analytic summary sensitivity and specificity were 85% (95% confidence interval [CI], 74-92%; I = 0%) and 98% (95% CI, 78-100%; I = 85%), respectively. In comparison with CT, MRI showed a higher sensitivity (85% vs. 75%) but similar specificity (98% vs. 94%).

Data Conclusion: MRI had good overall diagnostic performance for liver metastasis in patients with PDA, with a higher sensitivity than CT.

Level Of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1737-1744.
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http://dx.doi.org/10.1002/jmri.26969DOI Listing
June 2020

Low-Dose CT With the Adaptive Statistical Iterative Reconstruction V Technique in Abdominal Organ Injury: Comparison With Routine-Dose CT With Filtered Back Projection.

AJR Am J Roentgenol 2019 09 30;213(3):659-666. Epub 2019 Apr 30.

Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 305 Gudeok-Ro, Seo-Gu, Busan 49241, Korea.

The purpose of this study was to evaluate and compare the diagnostic performance and image quality of low-dose CT performed with adaptive statistical iterative reconstruction (ASIR)-V with those of routine-dose CT with filtered back projection (FBP) in the evaluation of abdominal organ injury. The study enrolled 197 patients with trauma who underwent multiphase abdominal CT, including routine-dose portal venous phase imaging with FBP and low-dose delayed phase imaging with 50% ASIR-V. The presence of abdominal organ injuries (liver, spleen, pancreas, kidney) was reviewed, and injuries were graded according to American Association for the Surgery of Trauma (AAST) scales. CT detection rates of organ injury and AAST grading with the two protocols were compared by McNemar test. Subjective analysis of image noise and artifacts and objective analysis of CT noise were performed by unpaired test. Compared with the routine-dose protocol, the low-dose protocol enabled an mean dose reduction of 59.8%. The detection rates and diagnostic performance of AAST grading did not differ significantly between the two protocols (detection rate, = 0.289; diagnostic performance, > 0.999). Objective image noise was significantly less with the low-dose protocol than with the routine-dose protocol ( < 0.001). Subjective imaging artifacts were similar between the low-dose and routine-dose protocols ( = 0.539). Compared with routine-dose protocol with FBP, low-dose CT with ASIR-V was useful for assessing multiorgan abdominal injury without impairing image quality.
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http://dx.doi.org/10.2214/AJR.18.20827DOI Listing
September 2019

Modified CAIPIRINHA-VIBE without view-sharing on gadoxetic acid-enhanced multi-arterial phase MR imaging for diagnosing hepatocellular carcinoma: comparison with the CAIPIRINHA-Dixon-TWIST-VIBE.

Eur Radiol 2019 Jul 16;29(7):3574-3583. Epub 2019 Apr 16.

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

Purpose: We evaluated the detection rate and degree of motion artifact of the modified CAIPIRINHA-VIBE (mC-VIBE) without view-sharing and compare them with the CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) with view-sharing on multi-arterial gadoxetic acid-enhanced liver MRI in the assessment of hepatocellular carcinoma (HCC).

Material And Methods: We retrospectively identified 114 pathological-proven hepatic tumors in 114 patients with risk of HCC who underwent multi-arterial gadoxetic acid-enhanced MRI between June 2016 and June 2018. All patients underwent triple arterial phase imaging using the mC-VIBE without view-sharing (54 patients; 49 HCCs and 5 non-HCCs) or the CDT-VIBE with view-sharing (60 patients; 55 HCCs and 5 non-HCCs). We compared the detection rate of two sequences for HCC, with reference to LI-RADS.V.2017. We also compared the mean motion scores and proportions of transient severe motion (TSM) in two sequences.

Result: For the examination using the mC-VIBE, the HCC-detection rate was significantly higher, compared with that using CDT-VIBE (93.9% [46/49] vs 80.0% [44/55], respectively; p = 0.047). For the examination with the mC-VIBE, mean motion scores were significantly lower compared with those of CDT-VIBE for all multi-arterial phases (1.21, 1.19, and 1.15 vs. 1.82, 1.85, and 1.84, respectively; p < 0.001 for all three comparisons). The proportion of TSM in the CDT-VIBE was significantly higher than that in the mC-VIBE (15.0% [9/60] vs 0.0% [0/54], respectively; p = 0.003).

Conclusion: In multi-arterial phase gadoxetic acid-enhanced MRI, the mC-VIBE sequence without view-sharing has slightly higher HCC-detection rate and fewer motion artifacts compared with CDT-VIBE with view-sharing.

Key Points: • Multi-arterial phase using the mC-VIBE without view-sharing can overcome motion artifacts, resulting in providing optimal arterial phase imaging. • The HCC-detection rate is slightly higher with the mC-VIBE vs. CAIPIRINHA-Dixon-TWIST-VIBE with view-sharing (CDT-VIBE). • View-sharing of CDT-VIBE in the multi-arterial phase is associated with increased frequency of TSM.
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http://dx.doi.org/10.1007/s00330-019-06095-xDOI Listing
July 2019

Prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma who have undergone radical nephrectomy.

Oncol Lett 2019 Mar 9;17(3):3009-3016. Epub 2019 Jan 9.

Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea.

The aim of the present study was to validate prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma (RCC) that have undergone nephrectomy treatment. The data from 356 patients who underwent nephrectomy were investigated and subsequently divided into 2 groups, according to the pulmonary metastasis status. The risk factors for pulmonary metastasis were examined in all patients. In the subgroup analysis, the risk factors were additionally verified in patients with pulmonary nodules using univariate and multivariate logistic regression analyses. The status of pulmonary nodules and pulmonary metastasis were confirmed through preoperative chest radiography by two radiologists. Pulmonary metastasis was observed in 33 (9.3%) patients with a median follow-up time of 54.4 months (interquartile range, 38.8-71.8). Patients with pulmonary nodules indicated significantly increased rates of pulmonary metastasis, compared with patients without pulmonary nodules (24.2 vs. 6.1%; P<0.001). In multivariate analysis, the presence of pulmonary nodules [hazard ratio (HR)=3.15; P=0.0262], albumin (HR=0.42; P=0.0490) and pTstage (HR=3.63; P=0.0475) were indicated to be independent prognostic markers for pulmonary metastasis. In subgroup analysis, pTstage was the only independent prognostic indicator for pulmonary metastasis in these patients (HR=9.81; P=0.0033). In patients with RCC, the presence of pulmonary nodules was associated with pulmonary metastasis. Furthermore, pTstage is a negative prognostic indicator in patients with pulmonary nodules. Therefore, a chest radiologic short-term follow-up is required for these patients.
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http://dx.doi.org/10.3892/ol.2019.9912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365916PMC
March 2019

Diagnostic performance of [F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis.

Eur Radiol 2019 Jul 4;29(7):3553-3563. Epub 2019 Feb 4.

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

Objectives: To systematically determine the diagnostic accuracy of 18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([F]FDG-PET/MRI) for the detection of liver metastases and evaluate the sources of heterogeneity in the reported results.

Methods: PubMed and EMBASE databases were searched up until December 31, 2017, to identify original research studies reporting the diagnostic performance (Se and Sp) of PET/MRI for liver metastases, in comparison with PET/CT. Study quality was assessed using QUADAS-2. The summary Se and Sp of the studies were estimated using hierarchical modeling methods. To determine causes of study heterogeneity, the presence of a threshold effect was analyzed, and meta-regression analysis was performed.

Results: Of 546 articles screened, eight suitable articles were identified, with seven for per-lesion analysis, and four for per-patient analysis. The meta-analytic summary Se and Sp for per-patient-based analysis were 99.2% (95% CI, 31.4-100.0%, I = 89.4%) and 98.6% (95% CI, 84.0-99.9%, I = 0.0%), respectively, while for per-lesion-based analysis they were 95.4% (95% CI, 78.3-99.2%, I = 99.7%) and 99.3% (95% CI, 93.8-99.9%, I = 96.5%). PET/MRI showed higher Se (95.4% vs. 68.3%) and Sp (99.3% vs. 95.8%) than PET/CT. Meta-regression analysis showed five significant factors affecting study heterogeneity: study subject characteristics, study design, MRI technique (DWI, HBP after injection of liver-specific contrast media), imaging review method, and reference standard.

Conclusion: The diagnostic accuracy of [F]FDG-PET/MRI for liver metastasis was high overall, but substantial heterogeneity was found. Further randomized controlled studies or prospective studies are needed to investigate the role of PET/MRI in liver metastasis in comparison with PET/CT.

Key Points: • [ F]FDG-PET/MRI has high meta-analytic Se and Sp for the diagnosis of liver metastasis. • PET/MRI using DWI and HBP images significantly increased diagnostic accuracy. • Study heterogeneity was associated with subject characteristics, study design, MRI technique, image review method, and reference standard.
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http://dx.doi.org/10.1007/s00330-018-5909-xDOI Listing
July 2019

Pancreatic Cancer CT: Prediction of Resectability according to NCCN Criteria.

Radiology 2018 12 25;289(3):710-718. Epub 2018 Sep 25.

From the Departments of Radiology and Research Institute of Radiology (S.B.H., S.S.L., J.H.K., H.J.K., J.H.B.), Pathology (S.M.H.), and Surgery (K.B.S., S.C.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea.

Purpose To evaluate the diagnostic performance of CT in the determination of pancreatic cancer resectability according to the National Comprehensive Cancer Network (NCCN) criteria to predict R0 resection. Materials and Methods Structured reports of pancreatic CT clinically prepared by board-certified abdominal radiologists from January 2014 to March 2017 were retrospectively reviewed to assess resectability (resectable, borderline resectable, or unresectable) according to NCCN criteria (version 1.2017) in 616 patients (369 men, 247 women; mean age, 63 years ± 10 [standard deviation]) with pancreatic cancer. Negative resection margin (R0) rates were assessed based on CT resectability status in patients who underwent upfront surgery. R0 resection-associated factors were identified by using logistic regression analysis. Results In 371 patients who underwent surgery, R0 resection rates were 73% (171 of 235), 55% (57 of 104), and 16% (five of 32) for resectable, borderline resectable, and unresectable disease, respectively (P < .001). At multivariable analysis, tumor diameter larger than 4 cm (P < .001) and abutment to the portomesenteric vein (P < .001) were significantly associated with margin-positive resection in patients with resectable disease at CT. R0 resection rates were 80% (123 of 154) for resectable disease without portomesenteric vein abutment, 59% (48 of 81) for resectable disease with portomesenteric vein abutment, 83% (57 of 69) for resectable disease 2 cm or smaller, and 29% (five of 17) for tumors larger than 4 cm. Conclusion CT resectability is used to stratify patients with pancreatic cancer according to the possibility of R0 resection. Larger tumor size and tumor abutment to the portomesenteric vein are associated with margin-positive resection in patients with resectable pancreatic cancer. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Fowler in this issue.
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http://dx.doi.org/10.1148/radiol.2018180628DOI Listing
December 2018

Ultra-low-dose lung screening CT with model-based iterative reconstruction: an assessment of image quality and lesion conspicuity.

Acta Radiol 2018 May 8;59(5):553-559. Epub 2017 Aug 8.

2 Department of Radiology, 220312 Pusan National University Hospital , Busan, Republic of Korea.

Background Reducing radiation dose inevitably increases image noise, and thus, it is important in low-dose computed tomography (CT) to maintain image quality and lesion detection performance. Purpose To assess image quality and lesion conspicuity of ultra-low-dose CT with model-based iterative reconstruction (MBIR) and to determine a suitable protocol for lung screening CT. Material and Methods A total of 120 heavy smokers underwent lung screening CT and were randomly and equally assigned to one of five groups: group 1 = 120 kVp, 25 mAs, with FBP reconstruction; group 2 = 120 kVp, 10 mAs, with MBIR; group 3 = 100 kVp, 15 mAs, with MBIR; group 4 = 100 kVp, 10 mAs, with MBIR; and group 5 = 100 kVp, 5 mAs, with MBIR. Two radiologists evaluated intergroup differences with respect to radiation dose, image noise, image quality, and lesion conspicuity using the Kruskal-Wallis test and the Chi-square test. Results Effective doses were 61-87% lower in groups 2-5 than in group 1. Image noises in groups 1 and 5 were significantly higher than in the other groups ( P < 0.001). Overall image quality was best in group 1, but diagnostic acceptability of overall image qualities in groups 1-3 was not significantly different (all P values > 0.05). Lesion conspicuities were similar in groups 1-4, but were significantly poorer in group 5. Conclusion Lung screening CT with MBIR obtained at 100 kVp and 15 mAs enables a ∼60% reduction in radiation dose versus low-dose CT, while maintaining image quality and lesion conspicuity.
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http://dx.doi.org/10.1177/0284185117726099DOI Listing
May 2018

The effects of strength exercise on hippocampus volume and functional fitness of older women.

Exp Gerontol 2017 10 14;97:22-28. Epub 2017 Jul 14.

Department of Radiology, College of Medicine, Pusan National University, Busan, Republic of Korea. Electronic address:

Background: Various positive effects of exercise on older women have been identified in many studies. Despite the importance of preserving the health of brain as well as body, few studies have investigated the effects of strength exercise on the brain health of older women to date. This study aimed to identify the effects of 24weeks of the Growing Stronger program on hippocampus volume and functional fitness of older women.

Methods: Twenty one older women aged 67 to 81 participated in this study. Growing Stronger, which is a strength exercise program that is safe and effective for women and men of all ages, was conducted. The 11 strength exercise group (n=11) participated for 50-80min a day three times per week for a total of 24weeks. The control group maintained their lifestyles without any special intervention. Participants were given a pre-test (before applying for the program) and post-test (after 24weeks) to identify effects of the program. The data were analyzed with repeated measures ANOVA.

Results: Hippocampus volume was significantly increased in the strength exercise group, but decreased in the control group. Moreover, there was an interaction effect (p<0.001) between time and group. Strength exercise has improved upper and lower body strength, lower body flexibility, agility, and dynamic balance. Upper body flexibility significantly decreased in the strength exercise group, but there was no interaction between the strength exercise group and the control group.

Conclusion: The results of this study suggest that strength exercise has beneficial effects on hippocampus volume and functional fitness. Therefore, strength exercise can be an effective exercise for older women.
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http://dx.doi.org/10.1016/j.exger.2017.07.007DOI Listing
October 2017