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Purpose@#The aim of this study was to evaluate the accuracy of prostate volume estimates calculated from the ellipsoid formula using the anteroposterior (AP) diameter measured on axial and sagittal images obtained through ultrasonography (US) and magnetic resonance imaging (MRI). @*Methods@#This retrospective study included 456 patients with transrectal US and MRI from two university hospitals. Two radiologists independently measured the prostate gland diameters on US and MRI: AP diameters on axial and sagittal images, transverse, and longitudinal diameters on midsagittal images. The volume estimates, volumeax and volumesag, were calculated from the ellipsoid formula by using the AP diameter on axial and sagittal images, respectively. The prostate volume extracted from MRI-based whole-gland segmentation was considered the gold standard. The intraclass correlation coefficient (ICC) was used to evaluate the inter-method agreement between volumeax and volumesag, and agreement with the gold standard. The Wilcoxon signedrank test was used to analyze the differences between the volume estimates and the gold standard. @*Results@#The prostate gland volume estimates showed excellent inter-method agreement, and excellent agreement with the gold standard (ICCs >0.9). Compared with the gold standard, the volume estimates were significantly larger on MRI and significantly smaller on US (P<0.001). The volume difference (segmented volume–volume estimate) was greater in patients with larger prostate glands, especially on US. @*Conclusion@#Volumeax and volumesag showed excellent inter-method agreement and excellent agreement with the gold standard on both US and MRI. However, prostate volume was overestimated on MRI and underestimated on US.
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Purpose@#To investigate the interocular difference of axial length (AL), mean keratometry (K), corneal astigmatism and anterior chamber depth (ACD) according to AL without history of ocular surgery. @*Methods@#This study was performed on 16,411 patients (32,825 eyes) who were measured AL, K, corneal astigmatism and ACD by IOL Master® from April 2007 to September 2016, excluding patients with missing values and extreme values in AL. After, patients were divided into four groups based on AL; AL < 24 mm, 24 mm ≤ AL < 26 mm, 26 mm ≤ AL < 28 mm, AL ≥ 28 mm, we investigated which variables were associated according to AL. To compensate for age and sex, 1:1:1:1 random matching was performed for age and sex. @*Results@#The longer the average AL of both eyes, the greater the difference between the AL, ACD and mean corneal K of both eyes. The longer AL group had the deeper ACD, the flatter mean corneal K, the higher corneal astigmatism. The older age group had the more shallow ACD, the steeper mean corneal K, lower corneal astigmatism. @*Conclusions@#Ophthalmologists have to be careful in setting fellow eye as control in treating or studying patients with long AL or axial myopia. Because, the longer the average AL of both eyes, the greater the difference between the AL, the ACD and the mean corneal K of both eyes.
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To provide high-quality training to residents in a rapidly changing medical environment, it is very important to improve the annual training curriculum centered on competency and ensure that training hospitals maintain an environment suitable for training. The Korean Society of Radiology (KSR) has been steadily improving the training system and has suggested the improvement of the training system by strengthening the competency-based evaluation and faculty development. Currently, KSR was selected for the second annual training curriculum systematization construction project in July 2021, and developed entrustable professional activities, core competencies, and assessment guidelines required by the construction project. Therefore, the development process and assessment guidelines will be introduced to residents and the faculty.
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Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.
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Objective@#We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm. @*Materials and Methods@#This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images.Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only. @*Results@#The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; p 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; p = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; p > 0.999). @*Conclusion@#Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.
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Objective@#To evaluate the feasibility of a new three-dimensional (3D) MR fingerprinting (MRF) technique for the prostate gland by conducting phantom and clinical studies. @*Materials and Methods@#The new 3D MRF technique used in this study enables quick data acquisition and has a high resolution. For the phantom study, the MRF T1 and T2 values in an in-house phantom were compared with those of goldstandard mapping methods using linear regression analysis. For the clinical study, we evaluated 90 patients who underwent prostate imaging with MRF for suspected prostate cancer between September 2019 and February 2020. The mean T1 and T2 values were compared in the peripheral zone, transition zone, and focal lesions using paired t tests. The differences in the T1 and T2 values according to cancer aggressiveness were evaluated using one-way analysis of variance. @*Results@#In the phantom study, the MRF T1 and T2 values showed a perfect correlation with the gold-standard T1 and T2 values (R > 0.99). In the clinical study, the T1 and T2 values in the peripheral zone were significantly higher than those in the transitional zone (p < 0.001, both). The T1 and T2 values in prostate cancer were significantly lower than those in the peripheral and transitional zones. The higher the grade of cancer, the lower the T2 values. @*Conclusion@#The T1 and T2 values obtained from the 3D MRF showed a perfect correlation with the gold standard values in the phantom study. Differences in the T1 and T2 values among the different zones of the prostate gland were identified using 3D MRF in patients.
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Objective@#We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm. @*Materials and Methods@#This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images.Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only. @*Results@#The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; p 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; p = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; p > 0.999). @*Conclusion@#Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.
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Objective@#To evaluate the feasibility of a new three-dimensional (3D) MR fingerprinting (MRF) technique for the prostate gland by conducting phantom and clinical studies. @*Materials and Methods@#The new 3D MRF technique used in this study enables quick data acquisition and has a high resolution. For the phantom study, the MRF T1 and T2 values in an in-house phantom were compared with those of goldstandard mapping methods using linear regression analysis. For the clinical study, we evaluated 90 patients who underwent prostate imaging with MRF for suspected prostate cancer between September 2019 and February 2020. The mean T1 and T2 values were compared in the peripheral zone, transition zone, and focal lesions using paired t tests. The differences in the T1 and T2 values according to cancer aggressiveness were evaluated using one-way analysis of variance. @*Results@#In the phantom study, the MRF T1 and T2 values showed a perfect correlation with the gold-standard T1 and T2 values (R > 0.99). In the clinical study, the T1 and T2 values in the peripheral zone were significantly higher than those in the transitional zone (p < 0.001, both). The T1 and T2 values in prostate cancer were significantly lower than those in the peripheral and transitional zones. The higher the grade of cancer, the lower the T2 values. @*Conclusion@#The T1 and T2 values obtained from the 3D MRF showed a perfect correlation with the gold standard values in the phantom study. Differences in the T1 and T2 values among the different zones of the prostate gland were identified using 3D MRF in patients.
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Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited.The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
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Purpose@#This study compared the technical parameters and clinical outcomes of manual and automatic image fusion techniques of ultrasonography and magnetic resonance imaging/computed tomography for radiofrequency ablation (RFA) of hepatic tumors. @*Methods@#Seventy consecutive patients (male:female=47:23, 67.1±10.9 years old) who underwent RFA for hepatic tumors were prospectively enrolled and randomly assigned to the manual or automatic registration group. Two operators performed RFA with one of two imaging fusion techniques. Technical parameters (the registration error, time required for image registration, number of point registrations) and clinical outcomes (technical success, technical effectiveness, local tumor progression [LTP]-free survival, and progression-free survival [PFS]) were compared. @*Results@#The automatic group contained 35 patients with hepatocellular carcinoma, while the manual group included 34 hepatocellular carcinoma patients and a patient with colon cancer liver metastasis. The registration error, time required for registration, and number of point registrations were 5.7±4.3 mm, 147.8±78.2 seconds, and 3.26±1.20 in the automatic group, and 6.3±5.0 mm, 150.3±89.7 seconds, and 3.20±1.13 in the manual group, respectively. The technical success and effectiveness rates were both 97.1% in the automatic group and both 100.0% in the manual group. The above differences were not significant. The LTP-free survival and PFS (28.3 and 21.2 months in the automatic group, and 29.0 and 24.9 months in the manual group, respectively) showed no significant between-group differences during a median 20.1-month follow-up period. @*Conclusion@#The technical parameters and clinical outcomes of automatic image fusion were not significantly different from those of manual image fusion for RFA of hepatic tumors.
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The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.
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Idoso , Feminino , Humanos , Exame de Medula Óssea , Bortezomib , Derme , Células Gigantes , Imunoeletroforese , Imunoglobulina G , Inflamação , Injeções Intralesionais , Melfalan , Mieloma Múltiplo , Pescoço , Xantogranuloma Necrobiótico , Paraproteinemias , Pele , Triancinolona , XantomatoseRESUMO
PURPOSE@#To evaluate the adherence rate to Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) minimum technical standards of prostate magnetic resonance imaging (MRI) in Korean medical institutions.@*MATERIALS AND METHODS@#This study included 103 prostate MRI examinations from 85 outside medical institutions performed from March 2015 to January 2018. The difference in adherence rate to minimal technical standards of PI-RADS v2 was compared using a Fisher's exact test between subgroups divided by the magnetic strength of MRI machine, type of medical institution and presence of genitourinary radiologist.@*RESULTS@#Diffusion-weighted imaging (DWI) was obtained frequently in examinations performed in a 3-T machine, in university hospitals and in medical institutions where genitourinary radiologist work in than the others (p < 0.001, p < 0.001, p = 0.003). Many minimum technical standards of PI-RADS v2 showed significantly lower adherence rate in a 1.5-T machine, in a non-university hospital and in a medical institution without genitourinary radiologist than the others.@*CONCLUSION@#The frequency of obtaining DWI and the adherent rate to some of the PI-RADS v2 minimum technical standards were significantly higher in 3-T machines, university hospitals and medical institutions with a genitourinary radiologist.
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PURPOSE: To evaluate the usefulness of wash-in color map in detecting early enhancement of prostate focal lesion compared to whole dynamic contrast-enhanced MRI (DEC MRI) images. MATERIALS AND METHODS: This study engaged 50 prostate cancer patients who underwent multiparametric MRI and radical prostatectomy as subjects. An expert [R1] and a trainee [R2] independently evaluated early enhancement and recorded the time needed to review 1) a wash-in color map and 2) whole DCE MRI images. RESULTS: The review of whole DCE images by R1 showed fair agreement with color map by R1, whole images by R2, and color map by R2 (weighted kappa values = 0.59, 0.44, and 0.58, respectively). Both readers took a significantly shorter time to review the color maps as compared to whole images (P < 0.001). CONCLUSION: A trainee could achieve better agreement with an expert when using wash-in color maps than when using whole DCE MRI images. Also, color maps took a significantly shorter evaluation time than whole images.
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Humanos , Imageamento por Ressonância Magnética , Próstata , Prostatectomia , Neoplasias da PróstataRESUMO
OBJECTIVE: To preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design. MATERIALS AND METHODS: The case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size. RESULTS: In the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively. CONCLUSION: The per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.
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Humanos , Carcinoma Hepatocelular , Estudos de Casos e Controles , Diagnóstico , Testes Diagnósticos de Rotina , Difusão , Estudos de Viabilidade , Hepatopatias , Fígado , Imageamento por Ressonância Magnética , Programas de Rastreamento , Sensibilidade e EspecificidadeRESUMO
The purpose of this study was to summarize the results of a survey for physicians with specialties other than radiology about imaging studies of patients referred from other institutions. The survey was promoted through individual contacts or social network service and physicians who voluntarily responded to the survey were the subjects of the study. The questionnaire consisted of 11 questions about basic information and referrals about medical imaging. A total of 160 physicians from 30 specialties participated in the survey and 95.6% of the respondents worked in tertiary care center or general hospital. Patients were frequently referred with outside medical images. The most frequently referred imaging modalities were computed tomography and magnetic resonance imaging. However, radiological reports from outside institutions were rarely referred. Most physicians thought that reinterpretation for outside imaging is necessary to acquire a secondary opinion. In conclusion, considering that outside radiological reports are frequently missing and there are high demands on reinterpretation for outside imaging, guidelines for referral of radiological reports with medical imaging, basic elements of radiological reports, and reinterpretation need to be developed.
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PURPOSE@#Establishment of an appropriate protocol for breast magnetic resonance imaging (MRI) in the study of image quality standards to enhance the effectiveness of medical image information exchange, which is part of the construction and activation of clinical information exchange for healthcare informatization.@*MATERIALS AND METHODS@#The recommended protocols of breast and MRI scans were reviewed and the questionnaire was prepared by a responsible researcher. Then, a panel of 9 breast dedicated radiologists was set up in Korea. The expert panel conducted a total of three Delphi agreements to draw up a consensus on the breast MRI protocol.@*RESULTS@#The agreed breast MRI recommendation protocol is a 1.5 Tesla or higher device that acquires images with prone position using a breast dedicated coil and includes T2-weighted and pre-contrast T1-weighted images. Contrast enhancement images are acquired at least two times, and include 60–120 seconds between images and after 4 minutes. The contrast enhancement T1-weighted image should be less than 3 mm in thickness, less than 120 seconds in temporal resolution, and less than 1.5 mm² in-plane pixel resolution.@*CONCLUSION@#The Delphi agreement of the domestic breast imaging specialist group has established the recommendation protocol of the effective breast MRI.
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Fibrous hamartoma of infancy (FHI) is a rare entity with a benign nature. The typical clinical features are a single, slowly growing, painless mass on the trunk that appears within the first 2 years of life. We report a 13-month-old boy who presented with a plaque on the lower back since 4 months of age. The plaque had gradually become larger and firm, and hyperhidrosis and hypertrichosis were noticed. No visible connection between the spinal cord and the lesion was found in radiologic studies, indicating a disease other than spinal dysraphism. Histopathological findings showed well-defined fibrous trabeculae, mature adipose tissue, and primitive mesenchymal cells, all consistent with FHI. This is the first case of FHI presenting with hyperhidrosis and hypertrichosis reported in Korea.
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Humanos , Lactente , Masculino , Tecido Adiposo , Hamartoma , Hiperidrose , Hipertricose , Coreia (Geográfico) , Medula Espinal , Disrafismo EspinalRESUMO
Typically, sporotrichosis follows an environmental transmission route via traumatic inoculation of contaminated plant or soil matter. Although familial occurrences of sporotrichosis are rare, human-to-human transmission is even rarer. Herein, we report two cases, a father and son, with sporotrichosis caused by Sporothrix (S.) globosa. A 33-year-old male who otherwise appeared healthy presented with a tender, erythematous, ulcerative crusted plaque on the left ala nasi and upper lip. A skin biopsy and mycological study revealed fixed cutaneous sporotrichosis. The patient irregularly received oral itraconazole with a relapsing course. Approximately a year later, his 3-year-old son developed a single plaque on the left leg. When the father carried his son on his shoulder, there was direct contact between the two lesions. Fungal culture results from the father and son's lesions confirmed S. globosa with ribosomal DNA ITS sequencing. In both patients, oral terbinafine exhibited better results than oral itraconazole. These cases are an excellent example of human-to-human transmission of sporotrichosis.