Bone Age Assessment Using Artificial Intelligence in Korean Pediatric Population: A Comparison of Deep-Learning Models Trained With Healthy Chronological and Greulich-Pyle Ages as Labels

Objective@#To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. @*Materials and Methods@#A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343;median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male:female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). @*Results@#Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. @*Conclusion@#The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.

Usefulness of ultrasonography in diagnosis of intestinal obstruction by a water bead

Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.

Clinical or Radiological Findings Suggestive of Spontaneous Intestinal Perforation in Extremely Low Birth Weight Infants with Gasless Abdomen

PURPOSE: This study aimed to evaluate the clinical and radiologic findings suggestive of spontaneous intestinal perforation (SIP) in extremely-low-birth-weight infants (ELBWIs) with persistent gasless abdomen, and to investigate the usefulness of abdominal ultrasonography for the diagnosis of SIP. METHODS: In total, 22 infants with birth weights less than 1,000 g who showed persistent gasless abdomen on simple abdominal radiography were included. Perinatal, neonatal, and perioperative clinical findings were retrospectively reviewed, and the risk factors for intestinal perforation were evaluated. Abdominal sonographic findings suggestive of intestinal perforation were also identified, and postoperative short-term outcomes were evaluated. RESULTS: In total, eight of the 22 infants (36.4%) with gasless abdomen had SIP. The number of infants with patent ductus arteriosus who were treated with intravenous ibuprofen or indomethacin was significantly higher in the SIP group than in the non-SIP group (P<0.05). Greenish or red gastric residue, abdominal distension, or decreased bowel sound were more frequent in infants with SIP (P<0.05), in addition to gray or bluish discoloration of abdomen, suggestive of meconium peritonitis (P<0.05). Pneumoperitoneum on simple abdominal radiography was found in only one of the eight infants (12.5%) with SIP. Intramural echogenicity and echogenic extramural material on abdominal ultrasonography were exclusively observed in infants with SIP. Four infants (50%) with SIP died after surgical intervention. CONCLUSION: Intestinal perforation may occur in ELBWIs with gasless abdomen. As intramural echogenicity and extraluminal echogenic materials on abdominal ultrasonography are indicative of SIP, this technique could be useful for diagnosing SIP.

Is Barium Enema Reliable for the Diagnosis of Total Colonic Aganglionosis? / 소아외과

PURPOSE@#Barium enema is one of the diagnostic modalities for Hirschsprung'sdisease. The present study aimed to investigate the diagnostic accuracy of barium enema for Hirschsprung's disease, especially total colonic aganglionosis (TCA).@*METHODS@#We retrospectively reviewed the medical records of all the patients who were diagnosed as having TCA and underwent a barium enema in Asan Medical Center Children's Hospital between January 1998 and December 2016. All the tests were performed and reviewed by pediatric radiologists.@*RESULTS@#Among the total 19 patients with TCA who underwent barium enema, 9 patients (47.4%) had accurate radiographic results. Eight of the 13 neonate patients (61.5%) showed typical TCA radiological findings. However, only one of the 6 patients aged >4 weeks (16.7%) had accurate radiological diagnosis.@*CONCLUSION@#Barium enema showed low accuracy for TCA, and its diagnostic performance was better in neonatal period than in those aged >4 weeks.

Is Barium Enema Reliable for the Diagnosis of Total Colonic Aganglionosis?

PURPOSE: Barium enema is one of the diagnostic modalities for Hirschsprung'sdisease. The present study aimed to investigate the diagnostic accuracy of barium enema for Hirschsprung's disease, especially total colonic aganglionosis (TCA). METHODS: We retrospectively reviewed the medical records of all the patients who were diagnosed as having TCA and underwent a barium enema in Asan Medical Center Children's Hospital between January 1998 and December 2016. All the tests were performed and reviewed by pediatric radiologists. RESULTS: Among the total 19 patients with TCA who underwent barium enema, 9 patients (47.4%) had accurate radiographic results. Eight of the 13 neonate patients (61.5%) showed typical TCA radiological findings. However, only one of the 6 patients aged >4 weeks (16.7%) had accurate radiological diagnosis. CONCLUSION: Barium enema showed low accuracy for TCA, and its diagnostic performance was better in neonatal period than in those aged >4 weeks.

Colonic Metastasis Presenting as an Intraluminal Fungating Mass 8 Years After Surgery for Ovarian Cancer

We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.

Assessment of Bone Age in Prepubertal Healthy Korean Children: Comparison among the Korean Standard Bone Age Chart, Greulich-Pyle Method, and Tanner-Whitehouse Method

OBJECTIVE: To compare the reliability of the Greulich-Pyle (GP) method, Tanner-Whitehouse 3 (TW3) method and Korean standard bone age chart (KS) in the evaluation of bone age of prepubertal healthy Korean children. MATERIALS AND METHODS: Left hand-wrist radiographs of 212 prepubertal healthy Korean children aged 7 to 12 years, obtained for the evaluation of the traumatic injury in emergency department, were analyzed by two observers. Bone age was estimated using the GP method, TW3 method and KS, and was calculated in months. The correlation between bone age measured by each method and chronological age of each child was analyzed using Pearson correlation coefficient, scatterplot. The three methods were compared using one-way analysis of variance. RESULTS: Significant correlations were found between chronological age and bone age estimated by all three methods in whole group and in each gender (R2 ranged from 0.87 to 0.9, p 0.01). CONCLUSION: The KS, GP, and TW3 methods show good reliability in the evaluation of bone age of prepubertal healthy Korean children without significant difference between them. Any are useful for evaluation of bone age in prepubertal healthy Korean children.

Correlation of Mast Cell Densities, Angiogenesis and Vascular Endothelial Growth Factor in Proper Muscle Gastric Carcinomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There are increasing evidences that angiogenesis enhances tumor growth and biological aggressiveness in gastric carcinoma. Mast cells have been implicated in the angiogenic process, by secreting angiogenic factors including vascular endothelial growth factor (VEGF), or enzymes that degrade extracellular matrices. However, the exact nature of mast cells in relation to cancer is contradictory so we conducted retrospective studies, to find the significance of mast cell densities, and microvessel counts in each clinicopathologic factors, including VEGF expression, in proper muscle (PM) gastric carcinoma. MATERIALS AND METHODS: 52 specimens, obtained from patients with PM gastric carcinoma, were studied using the immunohistochemical methods, monoclonal antibodies for mast cell tryptase, factor VIII-related antigen and VEGF. RESULTS: Mast cell densities were significantly increased in diffuse histologic type (p=0.042), infiltrating margins (p3 cm (p=0.015), diffuse histologic type (p=0.038) and lymph node metastasis (p=0.001). Similarly there were significantly increased densities in VEGF positive tumors (p<0.0001). Pearson's correlation analysis revealed a significant relationship between mast cell densities and microvessel counts (r=0.614, p<0.01), indicating a high vascular grade with increased number of mast cells. CONCLUSION: We demonstrated a close relationship between mast cell densities, microvessel counts and VEGF expression. These results suggest that mast cells and VEGF are important regulators of tumor angiogenesis and cooperatively induce the formation of vascular stroma in PM gastric carcinomas.

Expression of p27Kip1 Protein in Colorectal Adenocarcinoma

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.

A case of primary bilateral adrenal non-Hodgkin's lymphoma / 대한내과학회지

Primary adrenal lymphoma is extremely uncommon. The tumor is accidentally discovered by abdominal ultrasonography(USG), computed tomography(CT) or magnetic resonance imaging (MRI) in patients with nonspecific symptoms and diagnosed at operation or autopsy. In this case, a 60-year-old man was admitted for the evaluation of mild left frank discomfort for two months before admission. The abdominal USG was performed and showed the dense masses in both adrenal glands. The laboratory tests including blood count, chemistry and hormonal tests showed the normal levels except for the basal ACTH level of 108 pg/ml(normal range: 9~52 pg/ml). The 123I MIBG scan was normal. The bilateral adrenalectomy was done. The tumor was diagnosed as diffuse large B-cell non-Hodgkin's lymphoma(NHL) according to the Revised European-American lymphoma(REAL) classification. He was treated with the adjuvant combination chemotherapy of CHOP(cyclophosphamide, adriamycin, vincristine and prednisolone) but expired due to sepsis after the second chemotherapy. We describe the first case of primary bilateral adrenal NHL in Korea. Primary adrenal lymphoma should be included in the differential diagnosis of suprarenal mass.

Squamous Cell Carcinoma Associated with Chronic Empyema Caused by Metallic Fo reign Body: A Case Report

Malignant neoplasm associated with chronic empyema is rare. Most squamous cell carcinomas of the pleura may occur in association with chronic persistent empyema, with or without pleurocutaneous fistula. We report a case of squamous cell carcinoma associated with chronic empyema caused by a metallic foreign body.

A Case of Angiosarcoma of the Maxillary Sinus / 대한암학회지

Angiosarcomas are extremely rare in the nasal cavity and para-nasal sinus. Upto the present only nineteen cases have been reported in the literature. A 31-year-old male presented with right facial swelling and large oral cavity mass. He was treated with wide excision of the tumor by radical maxillectomy. The tumor was diagnosed as angiosarcoma by immunohistochemical staining with factor VIII-reactive antigen. No adjuvant radiotherapy after surgery was done. After 9 montbs from surgery, the tumor recurred in the primary sites of oral cavity and right maxillary sinus and metastasized to the both lungs. He was treated with palliative chemotherapy and showed a stable disease in follow-up magnetic resonance image of para-nasal sinus and simple chest X-ray after second cycle of chemotherapy. He is undergoing further chemotherapy without any problems. We report first in Korea a case of primary angiosarcoma of the right maxillary sinus in a 31-year-old male.

Two Cases of Recurrent Extramammary Paget's Disease after Wide Local Excision / 대한피부과학회지

We report two cases of recurrent extramarnmary Pagets disease after wide local excision. Both cases involved the scrotum and the penoserotal junction, respectively. On histopathological examination, we could observed many Paget cells confined to the epidermis and the hair follicle, but not invading the underlying dermis in both cases. There was no evidence of internal malignancy. Both cases were treated with wide local reexcision.

A Case of Recurred Primary Mediastinal Nonseminomatous Germ Cell Tumor Associated with Klinefelters Syndrome / 결핵

Primary mediastinal nonseminomatous germ cell tumor associated with Klinefelter's syndrome is a rare disorder. We experienced a case of recurred primary mediastinal nonseminomatous germ cell tumor developed in a 24-year-old patient with Klinefelter's syndrome. The patient had been treated with surgery and combination chemotherapy under the diagnosis of primary mediastinal nonseminomatous germ cell tumor before. A round mass was found on the right lower lung field in the chest X-ray during follow up. The patient was diagnosed as recurred primary nonseminomatous germ cell tumor and Klinefelter's syndrome through tumor markers, peripheral blood karyotyping, and other tests including hormonal assay and was treated with combination chemotherapy and surgery again. When the patient is diagnosed as primary mediastinal nonseminomatous germ cell tumor, Klinefelter's syndrome and hematologic malignancies should be considered to be associated diseases and vice versa.

Ovarian Mucinous Cystadenocarcinoma in 17-year-old Girl: A Case Report

Malignant epithelial neoplasm usually occurs in postmenopausal women, with less than 10% of cases occurring in women under the age of 20. In patients below this age, the majority of ovarian tumors are of germ cell origin and malignant ovarian epithelial tumors are uncommon. We report US & CT imaging in a case of mucinous cystadenocarcinoma in a 17-year-old nullipara who complained of amenorrhea for 45 days and a palpable mass.

Cystic Lymphangioma of Breast: A Case Report

Cystic lymphangioma are rare benign tumors that originate as a congenital anomaly of the lymphatic system. Their common presentation is in neck and axillary area at the birth, during infancy or early pediatric age group. Author reports an unusual case of cystic lymphangioma of breast which was diagnosed in a 32-year-old woman. The findings were very dense, sharply defined, and multilobulated masses on mammography, and mu-Itiloculated echo free lesions on ultrasonogram.

A case of nontropical idiopathic splenomegaly / 대한혈액학회지

No abstract available.

Three Cases of Single Ventricle with Asplenia

No abstract available.