A Novel Magnetic Resonance Quality Assurance Phantom (KMRP-4):Multi-Site Comparison With the American College of Radiology Phantom

Purpose@#To propose a novel standard magnetic resonance imaging (MRI) phantom, hereafter called the Korea Magnetic Resonance Phantom-4th edition (KMRP-4). Its related quality control (QC) assessment protocols and its comparison with the American College of Radiology (ACR) phantom and its QC assessment protocols. @*Materials and Methods@#Internally, the KMRP-4 phantom is composed of cubic and triangular vessels, brain tissue structures, and a uniform region designed to facilitate a variety of QC protocols. Using magnetic resonance (MR) images of these structures, we quantitatively evaluated a total of 10 parameters, seven from those of existing ACR protocols (i.e., geometric accuracy, high-contrast spatial resolution, slice thickness accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting, and low-contrast object detectability) and three additional parameters for evaluating vessel conspicuity, brain tissue contrast, and signal-to-noise ratio (SNR) introduced in the KMRP-4 protocols. Twentytwo MRI systems of 0.32–3.0 T static magnetic field strength were tested using both ACR and KMRP-4 phantoms. Mann–Whitney U-tests were performed on the seven evaluation items of the ACR method to compare KMRP-4 and ACR methods. @*Results@#The results of Mann–Whitney U-test demonstrated that p-values were more than 0.05 for all seven items that could be assessed with both ACR and KMRP-4, indicating similar results between the two methods. Additionally, assessments of vessel conspicuity, brain tissue contrast, and SNR using the KMRP-4 method demonstrated utility of the KMRP-4 phantom. @*Conclusion@#A novel standard phantom and related QC methods were developed to perform objective, observer-independent, and semi-automatic QC tests. Quantitative comparisons of MR images with KMPR-4 and ACR phantoms were performed. Results demonstrated the utility of the newly proposed KMRP-4 phantom and its related QC methods.

Radiologic Findings of Polyacrylamide Gel Mammoplasty and Its Complications:A Report of Four Case Series and Review of Literature

Polyacrylamide gel (PAAG) has been used for augmentation mammoplasty in certain countries, such as China or Eastern European countries. However, owing to various complications, its use is currently banned in most countries. Nevertheless, because of the migratory stream of female from these countries, we also encounter patients with PAAG mammoplasty in Korea. Owing to the various imaging features of PAAG mammoplasty, it may interfere with the identification of malignancy or other pathologic conditions. Therefore, it is important to identify the imaging findings related to PAAG mammoplasty. However, there is limited literature on the radiologic findings of complications related to PAAG mammoplasty in Korea. Herein we report four cases of PAAG mammoplasty, the complications faced, and depict various radiologic features through multimodality imaging.

Differing benefits of artificial intelligence-based computer-aided diagnosis for breast US according to workflow and experience level

Purpose@#This study evaluated how artificial intelligence-based computer-assisted diagnosis (AICAD) for breast ultrasonography (US) influences diagnostic performance and agreement between radiologists with varying experience levels in different workflows. @*Methods@#Images of 492 breast lesions (200 malignant and 292 benign masses) in 472 women taken from April 2017 to June 2018 were included. Six radiologists (three inexperienced [<1 year of experience] and three experienced [10-15 years of experience]) individually reviewed US images with and without the aid of AI-CAD, first sequentially and then simultaneously. Diagnostic performance and interobserver agreement were calculated and compared between radiologists and AI-CAD. @*Results@#After implementing AI-CAD, the specificity, positive predictive value (PPV), and accuracy significantly improved, regardless of experience and workflow (all P<0.001, respectively). The overall area under the receiver operating characteristic curve significantly increased in simultaneous reading, but only for inexperienced radiologists. The agreement for Breast Imaging Reporting and Database System (BI-RADS) descriptors generally increased when AI-CAD was used (κ=0.29-0.63 to 0.35-0.73). Inexperienced radiologists tended to concede to AI-CAD results more easily than experienced radiologists, especially in simultaneous reading (P<0.001). The conversion rates for final assessment changes from BI-RADS 2 or 3 to BI-RADS higher than 4a or vice versa were also significantly higher in simultaneous reading than sequential reading (overall, 15.8% and 6.2%, respectively; P<0.001) for both inexperienced and experienced radiologists. @*Conclusion@#Using AI-CAD to interpret breast US improved the specificity, PPV, and accuracy of radiologists regardless of experience level. AI-CAD may work better in simultaneous reading to improve diagnostic performance and agreement between radiologists, especially for inexperienced radiologists.

Analysis of risk factors affecting suicidal ideation in South Korea by life cycle stage

Objectives@#This study analyzed risk factors for suicidal ideation in South Koreans from a life cycle perspective. @*Methods@#A secondary analysis was conducted of data collected in 2015 as part of the 6th Korea National Health and Nutrition Examination Survey (KNHANES). The participants comprised 5,935 individuals aged 12 years or older. The statistical analysis reflected the complex sampling design of the KNHANES, and the Rao-Scott chi-square test and multiple logistic regression analysis were performed. @*Results@#The prevalence of suicidal ideation was 5.7% in adolescents, 3.7% in young adults, 5.4% in middle-aged adults, and 7.0% in older adults. Depression and stress were risk factors in every stage of the life cycle. In those aged 12 to 19 years, activity restrictions were significantly associated with suicidal ideation. Education and subjective health status were risk factors in adults aged 20 to 39 years, and education, activity restrictions, and quality of life were the major risk factors in those aged 40 to 64 years. For adults 65 years of age or older, the risk of suicidal ideation was higher among those with inappropriate sleep time. @*Conclusion@#The risk factors for suicidal ideation were found to be different across stages of the life cycle. This suggests a need for individualized suicide prevention plans and specific government policies that reflect the characteristics of each life cycle stage.

Multidetector Computed Tomography in Patients with Femoral Neck Fracture for Assessing Osteoporosis: Comparison with Dual Energy X-Ray Absorptiometry

Purpose@#To evaluate the ability of the Hounsfield unit (HU) measurement of the femoral neck during multidetector computed tomography (MDCT) for assessing osteoporosis compared with dual-energy X-ray absorptiometry (DXA). @*Materials and Methods@#Forty-two patients with femoral neck fractures who underwent MDCT and DXA from July to December 2016 were included in this study. HU measurements were made of the cancellous portions of the normal contralateral femoral neck on MDCT. Bone mineral density (BMD) and T-scores were obtained at the femur DXA. Correlations of HU values with BMD and T-scores were analyzed using Spearman’s correlation test. @*Results@#The mean BMD and T-score of the femoral neck were 0.650 g/cm2 and -2.4, respectively. The mean HU values for the normal, osteopenia, and osteoporosis groups were 131.9, 98.9, and 41.3, respectively. HU values at the femoral neck were positively correlated with BMD (r2 = 0.670; p < 0.001) and T-scores (r 2 = 0.676; p < 0.001). @*Conclusion@#The HU values of the femoral neck on MDCT are significantly correlated with BMD and T-scores of femur DXA. The HU values may serve as a diagnostic tool for the screening of regional bone quality when MDCT is performed for other reasons.

Disseminated Peritoneal Leiomyomatosis with Atypical Features and Comorbid Uterine STUMP: a Case Report and Review of the Literature

Disseminated peritoneal leiomyomatosis (DPL) is a very rare benign disease, characterized by multiple solid subperitoneal or peritoneal smooth muscle nodules in abdominopelvic cavity and malignant transformation is extremely rare. Also, uterine smooth muscle tumors of unknown malignant potential (STUMP) is a rare tumor, which is regarded as subclassification in uterine smooth muscle tumors between benign and malignant criteria. Pathogenesis of DPL is uncertain, but increasing evidence of iatrogenic cause including laparoscopic myomectomy has been reported.We report a case of a 28-year-old female with previous history of laparoscopic myomectomy diagnosed with DPL with atypical feature and concurrent uterine STUMP using computed tomography (CT) and magnetic resonance imaging (MRI), as well as present a review of the literature.

Multidetector CT Findings of Acquired Spondylolysis and Spondylolisthesis after Posterior Lumbar Laminectomy

Purpose@#We aimed to analyze postoperative multidetector CT (MDCT) of acquired spondylolysis and spondylolisthesis after posterior lumbar laminectomy. @*Materials and Methods@#We enrolled 74 patients, from 2003 to 2017, who underwent posterior lumbar laminectomy with both pre and postoperative MDCT. The patients were categorized into the following two groups: group 1 without fusion and group 2 with fusion. We analyzed laminectomy width, level and location of spondylolysis or spondylolisthesis, facet changes, and fatty infiltration of paraspinal muscles on postoperative MDCT. @*Results@#Incidence of spondylolysis or spondylolisthesis was 4 of 20 patients in group 1 and 2 of 54 patients in group 2. The laminectomy width (%) was defined as the percentage of the width of laminectomy to total lamina length. Mean laminectomy width (%) in patients with spondylolysis or spondylolisthesis was 54.0 in group 1 and 53.2 in group 2, in contrast to that in patients without spondylolysis or spondylolisthesis, which was 35.0 in group 1. The spondylolysis was observed at the level of the laminectomy and below pars interarticularis in group 1 and below the fusion mass at isthmic region in group 2. @*Conclusion@#MDCT facilitates the diagnosis of postsurgical acquired spondylolysis and spondylolisthesis and demonstrates typical location of spondylolysis. Greater laminectomy width has been associated with occurrence of acquired spondylolysis and spondylolisthesis.

The impact of post-warming culture duration on clinical outcomes of vitrified-warmed single blastocyst transfer cycles / 대한생식의학회지

Objective@#The objective of the study was to compare the effects of long-term and short-term embryo culture to assess whether there is a correlation between culture duration and clinical outcomes. @*Methods@#Embryos were divided into two study groups depending on whether their post-warming culture period was long-term (20–24 hours) or short-term (2–4 hours). Embryo morphology was analyzed with a time-lapse monitoring device to estimate the appropriate timing and parameters for evaluating embryos with high implantation potency in both groups. Propensity score matching was performed to adjust the confounding factors across groups. The grades of embryos and blastoceles, morphokinetic parameters, implantation rate, and ongoing pregnancy rate were compared. @*Results@#No significant differences were observed in the implantation rate or ongoing pregnancy rate between the two groups (56.3% vs. 67.9%, p=0.182; 47.3% vs. 53.6%, p=0.513). After warming, there were more expanded and hatching/hatched blastocysts in the long-term culture group than in the short-term culture group, but there was no significant between-group difference in embryo grade. Regarding pregnancy outcomes, the completion of re-expansion was faster in women who became pregnant than in those who did not for both culture durations (long-term: 2.19±0.63 vs. 4.11±0.81 hours, p=0.003; short-term: 1.17±0.29 vs. 1.94±0.76 hours, p=0.018, respectively). @*Conclusion@#The outcomes of short-term culture and long-term culture were not significantly different in vitrified-warmed blastocyst transfer. Regardless of the post-warming culture time, the degree of blastocyst re-expansion 3–4 hours after warming is an important marker for embryo selection.

The impact of post-warming culture duration on clinical outcomes of vitrified-warmed single blastocyst transfer cycles / 대한생식의학회지

Objective@#The objective of the study was to compare the effects of long-term and short-term embryo culture to assess whether there is a correlation between culture duration and clinical outcomes. @*Methods@#Embryos were divided into two study groups depending on whether their post-warming culture period was long-term (20–24 hours) or short-term (2–4 hours). Embryo morphology was analyzed with a time-lapse monitoring device to estimate the appropriate timing and parameters for evaluating embryos with high implantation potency in both groups. Propensity score matching was performed to adjust the confounding factors across groups. The grades of embryos and blastoceles, morphokinetic parameters, implantation rate, and ongoing pregnancy rate were compared. @*Results@#No significant differences were observed in the implantation rate or ongoing pregnancy rate between the two groups (56.3% vs. 67.9%, p=0.182; 47.3% vs. 53.6%, p=0.513). After warming, there were more expanded and hatching/hatched blastocysts in the long-term culture group than in the short-term culture group, but there was no significant between-group difference in embryo grade. Regarding pregnancy outcomes, the completion of re-expansion was faster in women who became pregnant than in those who did not for both culture durations (long-term: 2.19±0.63 vs. 4.11±0.81 hours, p=0.003; short-term: 1.17±0.29 vs. 1.94±0.76 hours, p=0.018, respectively). @*Conclusion@#The outcomes of short-term culture and long-term culture were not significantly different in vitrified-warmed blastocyst transfer. Regardless of the post-warming culture time, the degree of blastocyst re-expansion 3–4 hours after warming is an important marker for embryo selection.

Relationship between Urate Crystal Deposits Detected by Dual-energy Computed Tomography and Bone Erosions in Symptomatic Gout Patients without Clinically Apparent Tophi

OBJECTIVE: Dual-energy computed tomography (DECT) allows sensitive detection of monosodium urate (MSU) crystal deposits in gout. However, the role of MSU deposits on DECT during the disease process of gout is not clear. The aim of our study was to evaluate the relationship between joint damage and MSU deposits detected by DECT in symptomatic non-tophaceous gout. METHODS: DECT scans of 51 gout patients without clinically apparent tophi were assessed. Individual ankle and foot joints and Achilles tendon insertion sites were evaluated for the presence of MSU deposits and bone erosions. The total volume of MSU crystal on DECT was quantified using an automated software program. Clinical and laboratory data at the time of the DECT evaluation were obtained from medical record. RESULTS: MSU deposits were detected in 92.2% of the patients evaluated. Median number and total volume of MSU deposit per patient was 5.0 and 0.6 cm3, respectively. Bone erosion was found in 54.9% of patients. MSU deposits in the first (1st) metatarsophalangeal (MTP) joints were significantly associated with presence of bone erosions (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.06~13.38, p=0.040). Older age and frequent gout attack were associated with development of bone erosion in patients with MSU deposits (OR 1.12 and 2.57, 95% CI 1.04~1.22 and 1.02~6.50, p-value 0.004 and 0.047, respectively). CONCLUSION: MSU deposits and erosions were frequently detected by DECT in symptomatic non-tophaceous gout patients, and MSU deposits in 1st MTP joints were associated with presence of bone erosions especially in patients with older age and frequent gout attack.

Primary Imaging Test for Suspected Traumatic Thoracolumbar Spine Injury: 2017 Guidelines by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed a primary imaging test for suspected traumatic thoracolumbar spine injury. This guideline was developed using an adaptation process involving collaboration between the development committee and the working group. The development committee, consisting of research methodology experts, established the overall plan and provided support on research methodology. The working group, composed of radiologists with expertise in musculoskeletal imaging, wrote the recommendation. The guidelines recommend that thoracolumbar spine computed tomography without intravenous contrast enhancement be the first-line imaging modality for diagnosing traumatic thoracolumbar spine injury in adults.

Idiopathic Primary Necrotizing Fasciitis of the Breast: A Case Report

Necrotizing fasciitis (NF) is a life-threatening infection characterized by extensive necrosis and inflammation of subcutaneous tissue and the fascia. Only a few cases of NF in the breast have been reported, and imaging findings of primary breast NF have not been described in the literature. As primary NF in the breast is extremely rare, it can be misdiagnosed as an abscess or cellulitis, and its diagnosis may be delayed. However, early diagnosis is crucial because delays can lead to fatal sepsis or requirement for total mastectomy. Herein, the authors report a rare case of primary breast NF that was diagnosed early using enhanced breast CT and successfully managed with local debridement. CT revealed a large cystic mass with an air-fluid level, a thickened deep fascia without remarkable enhancement, and extensive subcutaneous emphysema with subcutaneous fat infiltrations in the right breast.

Imaging Findings of Breast Metastasis from Squamous Cell Carcinoma of the Cervix: A Case Report

Metastasis from extramammary malignancy to the breast is rare, and metastasis of cervical cancer to the breast is quite uncommon. We report atypical sonographic findings of a rapid growing, single, and circumscribed mass with complex cystic and solid echo pattern in a 50-year-old female. The mass confirmed a metastasis from cervical cancer. It is rare, but the possibility of breast metastasis should be considered when a rapidly growing breast mass is located in between the parenchyma and subcutaneous fat layer.

The Diagnosis and Interventional Treatment of Deep Vein Thrombosis

Deep vein thrombosis (DVT), which usually occurs in the lower extremities, is the presence of a blood clot within a deep vein that causes symptoms by breaking the venous return. Many cases of calf vein DVT are asymptomatic, or display only mild symptoms. But in the case of a proximal DVT, it affects the venous flow through the entire lower extremity, which results in a post-thrombotic syndrome, or a pulmonary embolism, if the proper treatment isn't performed. The diagnosis of the DVT is made by a radiologic examination. An ultrasound is often used as a first line of diagnosis, but on the other hand, computed tomography venography has also been gaining traction as an alternative method. If diagnosed, finding the cause of the DVT is important, and in the case of a symptomatic proximal DVT, the combination of anticoagulation and interventional treatment can be used towards the recovery of the venous return, preventing complications.

Importance of Bone Marrow and Soft Tissue Edema to Improve the Diagnostic Accuracy of Lumbosacral MRI for Transverse Process Fractures and Sacral Fractures

PURPOSE@#To evaluate the magnetic resonance imaging (MRI) findings to improve the diagnostic accuracy for transverse process fractures and sacral fractures.@*MATERIALS AND METHODS@#The lumbosacral MRI scans of 214 patients (mean age, 60 years; male-to-female ratio, 85:129), who had spine trauma between January and November 2015 were included. Two radiologists evaluated the presence, number, level, and anatomic site of the fractures on MRI with computed tomography as reference standard. Imaging findings were described as cortical disruption, marrow edema, or soft tissue edema on T1-, T2-, and fat-suppressed T2-weighted images. A statistical analysis was performed to compare the diagnostic accuracy of the MRI pulse sequences for the transverse process and sacral fractures.@*RESULTS@#Of 168 fractures, 26 (15.5%) and 13 (4.9%) were in the transverse processes and sacra, respectively. A paravertebral soft tissue edema occurred in the transverse process fractures (80.8%) and presacral soft tissue and marrow edemas occurred in the sacral fractures (46.1%). The sensitivity for the transverse process fractures was 88% on the T2-weighted image. It was 92% on fat-suppressed T2- and T1-weighted images for sacral fractures.@*CONCLUSION@#Bone marrow and soft tissue edemas on the MRI could potentially improve the diagnostic accuracy of an MRI for fractures in the transverse process and sacrum.

MRI Findings of Intercostal Schwannoma: A Case Report

Intercostal schwannomas are uncommon, encapsulated neoplasms that originate in nerve sheaths of intercostal nerves. They account for less than 10% of primary neural tumors of the chest wall. Herein, we report a pathologically confirmed case of intercostal schwannoma with typical magnetic resonance imaging findings.

Adenosquamous Carcinoma of Duodenal Bulb Mimicking Subepithelial Tumor on Computed Tomography: A Case Report

Adenosquamous carcinomas of the duodenum are extremely rare neoplasms in which both glandular and squamous elements demonstrate malignant characteristics. Few cases of adenosquamous carcinoma involving the second or third segment of the duodenum have been reported in the literature. Herein, we report the first case of adenosquamous carcinoma of the bulb of the duodenum that mimicked subepithelial tumor on computed tomography in a 59-year-old man.

The Memory-Enhancing Effects of Liquiritigenin by Activation of NMDA Receptors and the CREB Signaling Pathway in Mice

Liquiritigenin (LQ) is a flavonoid that can be isolated from Glycyrrhiza radix. It is frequently used as a tranditional oriental medicine herbal treatment for swelling and injury and for detoxification. However, the effects of LQ on cognitive function have not been fully explored. In this study, we evaluated the memory-enhancing effects of LQ and the underlying mechanisms with a focus on the N-methyl-D-aspartic acid receptor (NMDAR) in mice. Learning and memory ability were evaluated with the Y-maze and passive avoidance tests following administration of LQ. In addition, the expression of NMDAR subunits 1, 2A, and 2B; postsynaptic density-95 (PSD-95); phosphorylation of Ca2+/calmodulin-dependent protein kinase II (CaMKII); phosphorylation of extracellular signal-regulated kinase 1/2 (ERK 1/2); and phosphorylation of cAMP response element binding (CREB) proteins were examined by Western blot. In vivo, we found that treatment with LQ significantly improved memory performance in both behavioral tests. In vitro, LQ significantly increased NMDARs in the hippocampus. Furthermore, LQ significantly increased PSD-95 expression as well as CaMKII, ERK, and CREB phosphorylation in the hippocampus. Taken together, our results suggest that LQ has cognition enhancing activities and that these effects are mediated, in part, by activation of the NMDAR and CREB signaling pathways.

Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers

PURPOSE: The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. METHODS: A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of < 0.05 were considered to indicate statistical significance. RESULTS: Of the 141 lesions, 75 (53.2%) were mass lesions, 56 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006). Microcalcifications were significantly associated with high-grade DCIS (P < 0.001), the presence of comedonecrosis (P < 0.001), an elevated Ki-67 (P < 0.001), and HER2 positivity (P=0.003). CONCLUSION: The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.

Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines

Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial disease than for deep vein thrombosis or varicose veins. Ultrasonography can diagnose stenosis through the direct visualization of plaques and through the analysis of the Doppler waveforms in stenotic and poststenotic arteries. To perform Doppler ultrasonography of the lower extremity arteries, the operator should be familiar with the arterial anatomy of the lower extremities, basic scanning techniques, and the parameters used in color and pulsed-wave Doppler ultrasonography.