Use of acidified versus non-acidified liquid human milk fortifier in very low birth weight infants: A retrospective comparison of clinical outcomes.

BACKGROUND: Use of human milk is recommended for low birth weight (VLBW) infants, but must be safety fortified with sterile liquid fortifiers to be nutritionally sufficient. Due to clinical concern for a high incidence of metabolic acidosis among VLBW infants fed human milk fortified with acidified liquid human milk fortifier (ALHMF), we aimed to retrospectively compare the outcomes of infants fed ALHMF to those fortified with non-acidified liquid HMF (NLHMF). METHODS: Medical records of VLBW neonates admitted to our institution's neonatal intensive care unit from July 1st, 2013 to June 30th, 2014 were reviewed. 129 patients were included in the study, 61 of which received ALHMF and 68 received NLHMF. Metabolic, nutritional and clinical outcomes, including growth, were compared between the two cohorts. RESULTS: Of the infants who received ALHMF, 70.5% developed metabolic acidosis compared to only 11.8% in the NLHMF group (p < 0.001). In addition, infants who received NLHMF had a 10% greater growth velocity during the period of fortification (p = 0.01). During the full course of hospitalization, no difference in growth velocity was seen between the groups and greater length gains were found in the ALHMF group. CONCLUSIONS: The use of human milk fortified with ALHMF was associated with an increased incidence of metabolic acidosis and poorer growth during the period of fortification when compared to NLHMF-fortified feedings. These growth effects were not apparent when the duration of hospitalization was considered, suggesting a need for further study to better characterize the advantages and disadvantages of each fortifier.

Advanced Test of Attention in Children with Attention-Deficit/Hyperactivity Disorder in Japan for Evaluation of Methylphenidate and Atomoxetine Effects.

OBJECTIVE: This study was conducted to validate the Advanced Test of Attention (ATA) of the visual attention version of Japanese children with attention deficit/hyperactivity disorder (ADHD) and to evaluate the efficacy of methylphenidate (OROS-MPH) and atomoxetine medications. METHODS: To assess pharmacotherapy efficacy, the visual version of ATA was administered to 42 children with ADHD. Results were assessed using discriminant analysis, ANOVA for indices of ATA before and after medication treatment, and correlation analysis between the improvement of indices of ATA and clinical symptoms during medication treatment. RESULTS: Discriminant analysis showed that 69.0% of ADHD children were assigned correctly. The T score of commission errors increased as the trial progressed on the medication-off condition. T scores of commission errors and standard deviation of response times on medication-on condition were low compared to the medication-off condition. A few significant correlations were found between the improvements of indices of ATA and ADHD-Rating Scale (RS) during treatment. CONCLUSION: The performance of the visual version of ATA on medication-off condition reflected the features of ADHD. Furthermore, the medication treatment effects were confirmed sufficiently. In addition, results suggest that indices of ATA reflected aspects of ADHD symptoms that are difficult to elucidate for ADHD-RS. For assessing symptoms and effects of medical treatment in children with ADHD, ATA might be a useful assessment tool.

Advanced Test of Attention in Children with Attention-Deficit/Hyperactivity Disorder in Japan for Evaluation of Methylphenidate and Atomoxetine Effects

OBJECTIVE: This study was conducted to validate the Advanced Test of Attention (ATA) of the visual attention version of Japanese children with attention deficit/hyperactivity disorder (ADHD) and to evaluate the efficacy of methylphenidate (OROS-MPH) and atomoxetine medications. METHODS: To assess pharmacotherapy efficacy, the visual version of ATA was administered to 42 children with ADHD. Results were assessed using discriminant analysis, ANOVA for indices of ATA before and after medication treatment, and correlation analysis between the improvement of indices of ATA and clinical symptoms during medication treatment. RESULTS: Discriminant analysis showed that 69.0% of ADHD children were assigned correctly. The T score of commission errors increased as the trial progressed on the medication-off condition. T scores of commission errors and standard deviation of response times on medication-on condition were low compared to the medication-off condition. A few significant correlations were found between the improvements of indices of ATA and ADHD-Rating Scale (RS) during treatment. CONCLUSION: The performance of the visual version of ATA on medication-off condition reflected the features of ADHD. Furthermore, the medication treatment effects were confirmed sufficiently. In addition, results suggest that indices of ATA reflected aspects of ADHD symptoms that are difficult to elucidate for ADHD-RS. For assessing symptoms and effects of medical treatment in children with ADHD, ATA might be a useful assessment tool.

Neuropsychological and behavioral profiles in attention-deficit hyperactivity disorder children of parents with a history of mood disorders: a pilot study.

OBJECTIVE: We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects. METHODS: We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children's current mood state and familial functioning to control for the confounding effects of these variables. RESULTS: Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children's current mood state and familial functioning. CONCLUSION: Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.

Neuropsychological and Behavioral Profiles in Attention-Deficit Hyperactivity Disorder Children of Parents with a History of Mood Disorders: A Pilot Study

OBJECTIVE: We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects. METHODS: We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children's current mood state and familial functioning to control for the confounding effects of these variables. RESULTS: Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children's current mood state and familial functioning. CONCLUSION: Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.

The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents.

OBJECTIVE: This study used a sample of Korean adolescents to evaluate: (a) associations between problematic internet use and depression, bipolar disorder symptoms and suicidal ideation; and (b) whether mood disorders mediate the relationship between problematic internet use and suicidal ideation. METHOD: A total of 795 middle and high school students were recruited (538 girls; mean age, 13.87 ± 1.51 years). The Internet Addiction Proneness Scale for Youth-Short Form (KS-scale) was used to evaluate the presence and severity of problematic internet use. The frequencies of depression, suicidal ideation and probable bipolar disorder were compared between adolescents with and without internet addiction. The associations between the severity of problematic internet use and the severity of depressive symptoms, bipolar symptoms and suicidal ideation were also analyzed. RESULTS: Seventy-five adolescents (9.4%) met the criteria for problematic internet use. The presence of problematic internet use was significantly associated with suicidal ideation (OR = 5.82, 95% CI = 3.30-10.26, p < 0.001) as well as depression (OR = 5.00, 95% CI = 2.88-8.66, p < 0.001). There was a marginally significant association between problematic internet use and probable bipolar disorder (OR = 3.05, 95% CI = 0.96-9.69, p = 0.059). In the path model, problematic internet use significantly predicted depressive symptoms (ß = 0.296, 95% CI = 0.214-0.367, p = 0.005), which predicted suicidal ideation (ß = 0.699, 95% CI = 0.631-0.751, p = 0.009). Problematic internet use also predicted suicidal ideation directly (ß = 0.115, 95% CI = 0.052-0.193, p = 0.006). Conversely, depressive symptoms (ß = 0.119, 95% CI = -0.005-0.219, p = 0.040) and suicidal ideation (ß = 0.215, 95% CI = 0.089-0.346, p = 0.005) predicted problematic internet use. CONCLUSIONS: There is a complex transactional relationship between problematic internet use, depressive symptoms, bipolar symptoms and suicidal ideation, so these conditions must be assessed together during the evaluation of adolescents. Prospective studies are warranted to elucidate the causal relationships between problematic internet use, mood symptoms and suicidal ideation.

The Characteristics of Suicide Attempts and Psychosocial Risk Factors in Correctional Institutions / 신경정신의학

OBJECTIVES: Suicide is one of the most common causes of deaths in correctional institutions. This study aimed to examine the characteristics of suicide attempts and its related psycho-social factors in correctional institutions. METHODS: This study examined the characteristics of 101 suicide attempts from 2006 to 2007 in the two regional correctional headquarters. Thirty-seven male inmates (43 suicide attempts) and 40 matched controls were included in interviews and reviews of personal records. Psychiatric illnesses were examined using the Structured Clinical Interview for DSM-IV and medical outcomes of their suicide attempts with the Lethality Scale of Diagnostic Interview for Genetic Studies. RESULTS: Over a half of suicide attempts occurred in solitary cells and the most common method was hanging. Medically, 70% of the suicide attempts were more than severe. Poor social support, a lifetime history of suicide attempts, and incarceration were associated with suicide attempts. Additionally, psychiatric illnesses were more likely to increase the risk of suicide. CONCLUSION: This study implies that mental health issues and monitoring systems are important to reduce suicides in the correctional system. Regular checks and management of suicide risk and mental illness are crucial to prevent suicide in correctional institutions.

The reliability and validity of the junior temperament and character inventory.

The purpose of this study was to evaluate the reliability and validity of the Junior Temperament and Character Inventory (Junior TCI), a child and adolescent version of the Adult Temperament and Character Inventory (TCI), which is based on Cloninger's biosocial model of personality. The Junior TCI was translated into Korean and administered to 663 Korean middle school students (male/female, 360/303; age, 13.3 +/- 1.0 years) and their parents (mother/father, 444/84). Internal consistency was calculated by Cronbach alpha. A test-retest study of the Junior TCI was conducted across a 3-month interval with 97 subjects. Factor analyses for the temperament and character dimensions were performed using principal component analysis, rotating factors by Promax. Cronbach alpha values of the Junior TCI scales ranged from.48 to.80 for the temperament scales and from.64 to.68 for the character scales. Test-retest correlations ranged from.62 to.85 for the temperament scales and from.76 to.79 for the character scales. Principal component factor analyses showed three factors out of four temperament scales (Harm Avoidance 1 to 4; Novelty Seeking 1 to 4; Persistence; and Reward Dependence 1, 3, 4) and three factors out of three character scales (Self-Directedness 1 to 5; Cooperativeness 1 to 5; and Self-Transcendence 1 to 3) that were similar to factor structures of adult versions of the TCI. Explorative factor analysis with a condition of eigenvalue greater than 1 produced six factors, as compared to seven factors extracted in Cloninger's original report of the adult TCI. In conclusion, this was the first study to tests and report detailed psychometric properties of the Junior TCI. The current study confirms that the Junior TCI has satisfactory psychometric properties for the use in child and adolescent populations and reflects Cloninger's biosocial model of personality.

Persistent low-level engraftment of rhesus peripheral blood progenitor cells transduced with the fanconi anemia C gene after conditioning with low-dose irradiation.

The hematopoietic stem cell has long been considered an ideal target for the introduction of therapeutic genes to treat human disorders such as Fanconi anemia (FA). Although recent progress in large animal models is encouraging, application to nonmalignant conditions is limited by the perceived necessity of myeloablative conditioning. We and others have shown that very low irradiation doses are sufficient to allow significant hematopoietic engraftment in murine hosts even after the introduction of xenogeneic genes. To determine the degree of engraftment of genetically modified cells attainable with very low irradiation doses in larger animals, we employed the rhesus macaque competitive repopulation model. Four animals underwent mobilization with stem cell factor (SCF) and granulocyte colony-stimulating factor (G-CSF) followed by apheresis. The apheresis product was enriched for the CD34-positive fraction by immunomagnetic selection and split equally for transduction with either G1FC26, a retroviral vector carrying the Fanconi anemia complementation group C gene, or PLII, a nonexpression control retroviral vector carrying both neomycin and beta-galactosidase gene sequences modified to prevent translation. Transductions were performed daily in the presence of fresh IL-3, IL-6, SCF, and Flt-3 ligand on fibronectin-coated plates over 96 h. Animals were conditioned with a single dose of either 100 (n = 2) or 200 (n = 2) cGy and received the combined products of transduction on the following day. None of the animals experienced clinically significant neutropenia nor required the use of central line placement, transfusional support with blood products, or intravenous antibiotics. Using real-time PCR, circulating levels of genetically modified cells as high as 1% were initially detected. Stable, albeit, significantly lower levels from both vector-transduced aliquots (<0.1%) persisted beyond 12 months posttransplant in all four animals. Although not sufficient to correct the phenotype in many human disorders, stable low-level engraftment by genetically modified cells following low-intensity conditioning may prove adequate in disorders such as FA due to the selective advantage conferred upon corrected cells.

High-performance liquid chromatographic analysis of saponin compounds in Bupleurum falcatum.

A mixture of saponin compounds (saikosaponin c, a, and d) in the 70% ethanol extract of a powdered sample of Bupleuri radix are analyzed by an Inertsil ODS-3 C(18) column at a flow rate of 1.0 mL/min and detection wavelength of 203 nm. Well resolved chromatograms of saikosaponin c, a, and d are obtained with a gradient elution of acetonitrile-water from 40:60 (v/v) to 50:50 (v/v). The total time required for a single analysis is approximately 20 min. Calibration curves for saikosaponin c, a, and d are linear up to 2.5 mg/mL. The coefficient of variability values for saikosaponins in the extract are below 4%, and the recoveries for saikosaponin c, a, and d are 95.2 +/- 1.1, 96.5 +/- 0.9, and 96.2 +/- 1.0%, respectively. The changes in saikosaponin contents for a two-year growth of Bupleurum falcatum are measured by the established high-performance liquid chromatography method.

Fast T2-weighted liver MR imaging: comparison among breath-hold turbo-spin-echo, HASTE, and inversion recovery (IR) HASTE sequences.

BACKGROUND: To evaluate the diagnostic efficacy of fast T2-weighted magnetic resonance (MR) imaging sequences on image quality, hepatic lesion detection, and lesion conspicuity. METHODS: Three breath-hold, fast T2-weighted sequences with turbo-spin-echo (TSE), half-Fourier acquisition single-shot TSE (HASTE), and inversion recovery (IR) HASTE techniques were examined for 43 lesions in 20 consecutive patients. Evaluation was performed qualitatively on image quality and lesion detectability and quantitatively on lesion conspicuity by using lesion/liver signal-intensity and contrast-to-noise ratios. RESULTS: Artifacts were significantly less present on the HASTE sequence (p < 0.01). Both TSE and HASTE sequences detected 39 lesions (91% each); the IR HASTE sequence detected 37 (86%). IR HASTE sequence showed a significantly higher signal-intensity ratio than did the others (p < 0.01). CONCLUSIONS: Breath-hold TSE versus breath-hold HASTE or IR HASTE is still the most robust sequence in lesion detection, image quality, and lesion conspicuity. However, the HASTE sequence offers good lesion detection and image quality, and the IR HASTE has a better signal-intensity ratio.

MR cholangiopancreatography of pancreaticobiliary diseases: comparing single-shot RARE and multislice HASTE sequences.

OBJECTIVE: In this study, we compared the single-shot rapid acquisition with relaxation enhancement (RARE) sequence with the multislice half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence to assess the ability of each technique to show various pancreaticobiliary diseases using MR cholangiopancreatography. SUBJECTS AND METHODS: MR cholangiopancreatography was performed using both the single-shot RARE and the multislice HASTE pulse sequences in 80 consecutive subjects in whom we had proof of a range of diagnoses. The study population included healthy subjects (n = 9), patients with benign lesions (n = 41), and patients with malignant lesions (n = 30). We analyzed each image using the following criteria: the cause of the lesions, the image quality (i.e., the amount of artifact and the sharpness of anatomic structures such as the right and left hepatic ducts, the extrahepatic bile duct, and the main pancreatic duct), and the reviewers' preference of images. The images were evaluated independently by two radiologists who were unaware of the results of the other cholangiopancreatographic sequence and of the diagnosis. RESULTS: Artifacts were less prominent in images that were obtained using the single-shot RARE sequence (p = .0192); however, the sharpness of anatomic structures was the same using either sequence (p = .1673). For images that were obtained using the single-shot RARE technique, the sensitivity, specificity, and accuracy in distinguishing malignant from other abnormalities were 83%, 78%, and 80%, respectively; for the multislice HASTE technique, these values were 77%, 72%, and 74%, respectively (p > .05). Disease-specific accuracy in determining the correct diagnosis was 54% and 59%, respectively (p > .05). In patients in whom all the ducts needed to be defined, the single-shot RARE technique was preferred to the multislice HASTE technique (p < .01). CONCLUSION: The single-shot RARE technique shows fewer artifacts and is preferred to the multislice HASTE technique. However, both techniques show the same degree of sharpness of anatomic structures, both are able to reveal malignant diseases, and both provide enough information to determine a specific diagnosis.

Effects of the Family Environment and the Biogenetic Temperament/Character on the Emotional and Behavioral Aspects of the Filial Piety / 신경정신의학

OBJECTIVE: This study aimed to tap the influence of the childhood and adolescent family environment and biogenetic temperament/character on the filial piety profile, i.e., its behavioral and emotional aspects in Korean college students. METHODS: Ninety-eight college students(male=49, female=49, the main study group) in the Seoul Metropolitan area were selected using multi-stage(randomized) cluster procedures. Their parents(N=174) became the 'generation' comparison group. The Filial Piety Scale was used to evaluate the perception of filial piety, both in 13 individual items and in two factor-analytically- produced behavioral and emotional aspects of filial piety. The Family Environment Scale was used to evaluate the childhood and adolescent family environment. The Temperament and Character Inventory was used to assess biogenetic temperament and character of the study subjects. RESULTS: Parents of college students scored significantly higher on filial piety items of familial harmony, responsibility/obligation, sacrifice, compensation, neighborhood harmony, and family continuity than their offspring did. There were no significant differences between study subjects and their parents in perceiving their family environment. Childhood environment with high moralethical emphasis and high achievement orientation was significantly correlated with the behavioral aspect of filial piety whereas cohesive and expressive family environment was shown to be linked to the emotional aspect of filial piety. Regarding the biogenetic temperament/character-filial piety relationship, low self-directedness was positively correlated with behavioral aspect of filial piety while high cooperativeness was positively correlated with emotional aspect of filial piety. CONCLUSIONS: This study reports distinct patterns of relationship between childhood family environment and the filial piety profile and between biogenetic temperament/character and the filial piety profile in Korean college students.

Cross-Cultural Study on the Development of Self-Image in Korean, Korean-Chinese and Chinese Adolescents / 신경정신의학

OBJECTIVES: In order to investigate the effect of cultural and ethnic differences on the development of self-image, we conducted a cross-cultural study on Korean, Korean-Chinese and Chinese adolescents. METHODS: A total of 1576 Korean middle and high school students in Seoul/Choongju, 665 Korean-Chinese students and 634 Chinese students living in Yunbyun, China participated in this study. The Korean version of the Offer Self-Image Questionnaire was administered to Korean students, and the Chinese version of the questionnaire was administered to Korean-Chinese and Chinese students. The data obtained from all subjects were analyzed according to ethnicity and age variable through ANOVA. RESULTS: A significant difference across ethnicity was found in the 12 subscales and the total self-image score of OSIQ-R. Korean adolescents obtained significantly higher scores in all of the 11 subscales except the sexuality subscale than Korean-Chinese and Chinese adolescents. Korean-Chinese adolescents obtained significantly higher scores on the ethical value, idealism, family functioning, social functioning, impulse control, self-confidence and total self-image scores than Chinese adolescents, whereas Chinese adolescents obtained significantly higher scores in the subscales of emotional tone, sexuality, vocational attitudes, and self-reliance than Korean-Chinese adolescents. CONCLUSION: The results suggest the possibility that the difference in ethnicity(Korean versus Chinese), the tradition associated with each ethnic group, and the cultural-political factor(democracy versus socialism) significantly affects the development of self-image in adolescents. Although Korean-Chinese adolescents seemed to show cultural pluralism between Korean and Chinese cultures, they were similar to Korean adolescents in their tendency to respond in socially desirable ways, which suggests that although raised under the different cultural systems, traditional Korean ethical values were learned and internalized within the family.

A Standardization Study of the Korean Version of Learning Disability Evaluation Scale / 신경정신의학

OBJECTIVES: This study was to develop the Korean version of Learning Disability Evaluation Scale(K-LDES), to examine the reliability and validity of it, and to establish the age norms of the K-LDES for assessing the specific learning disorder. METHODS: The normative group was composed of 720 children between the age of 6 and 12. The clinical group consisted of 27 children with learning disorder and 25 children with attention deficit hyperactivity disorder accompanying learning problem(mean age=108.44month+/-6.60, mean FSIQ=108.61+/-13.47). The K-LDES as administered to teachers of the normative and clinical groups. The KEDI-WISC and the Basic Learning Test(BLT) were administerd to the clinical group. RESULTS: The reliability coefficients(Cronbach's alpha) of the K-LDES were ranged .92-.97 and the correlation coefficients between the K-LDES subscales were moderate to high. The subscales of K-LDES were significantly correlated with the subtests of KEDI-WISC and BLT. Principal component analysis with varimax rotation resulted five factors, which are similar to those of original LDES, strongly supporting the construct validity of the K-LDES. There was significant differences between the normal and the clinical groups on six subscales of K-LDES except arithmetic subscale, implying that the K-LDES is a more valid measure for assesing reading and writing disorders. The discriminant power of each items were calculated, and 71 of the 88 items discriminated significantly between the normal and the clinical groups. In order to establish norms of K-LDES for six age levels, the means and standard deviations of subscale raw scores for normative group were used to calculate subscale standard scores at a given age, and LQ was determined by adding 7 subscale standard scores and being converted standard score with a mean of 100 and a standard deviation of 15. CONCLUSION: K-LDES was found to be a reliable and valid instrument for screening specific learing disorder. The expectation is that K-LDES will be a useful teacher/mother rating measure for identifying learning disorder and providing information which may contribute to diagnosing and developing individualized educational program for identified problem areas.

A Standardization Study of the Korean Version of Offer Self-Image Questionnaire-Revised / 신경정신의학

OBJECTIVES: This study was carried out to develop Korean version of Offer Self-Image Questionnaire-revised(OSIQ-R) designed to assess the self-image in adolescence. METHODS: We applied the translated OSIQ-R to 1,602 Korean middle school and Korean higher school adolescents and conducted retest with 6 weeks' interval. Together with OSIQ-R, Korean form of Symptom Checklist 90-R was applied to all subjects for testing of concurrent validity. We also examined whether this scale discriminates between clinical and normal population in the self-image. RESULTS: Test-retest reliability, internal consistency were very much satisfactory and concurrent validity with other scales. There were significant differences by school, sex and locality in the global self-image. However, comparison of normal and conduct disorder adolescents failed to show significant differences. CONCLUSIONS: In global self-image, reliability and validity of OSIQ-R were sufficient. To get the further validity, more comparative studies of clinical population are required. Additional studies like this, will establish basic normative data and make Korean form of OSIQ-R more useful.

Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography.

PURPOSE: To assess the diagnostic value of three-dimensional (3D) magnetic resonance (MR) cholangiopancreatography versus endoscopic retrograde cholangiopancreatography (ERCP) in various pancreaticobiliary diseases. MATERIALS AND METHODS: Forty-six consecutive adult patients suspected to have extrahepatic biliary disease were examined. Breath-hold 3D steady-state free-precession MR cholangiopancreatography was performed. Correct determination of the level of biliary obstruction (n = 23) and of the cause of lesions (n = 46) was independently assessed with both MR cholangiopancreatography and ERCP by two readers blinded to the diagnosis. Results were compared. The overall diagnostic accuracies of both modalities also were compared. RESULTS: Level of obstruction was accurate in 91% (21 of 23) with MR cholangiopancreatography and in 83% (19 of 23) with ERCP (P > .05). The sensitivity, specificity, and accuracy in distinguishing malignant from benign lesions were 81%, 92%, and 87%, respectively, for MR cholangiopancreatography and 71%, 92%, and 83%, respectively, for ERCP. However, the differences were not significant (P > .05). The overall diagnostic accuracies of MR cholangiopancreatography and ERCP were 72% and 61% (P > .05), respectively. CONCLUSION: 3D MR cholangiopancreatography not only is fast and reliable in evaluating the extrahepatic bile duct, but also offers a diagnostic value equivalent to that of ERCP.

Color Doppler flow imaging of hepatocellular carcinomas. Comparison with metastatic tumors and hemangiomas by three-step grading for color hues.

The role of color Doppler imaging was evaluated in differentiating hepatocellular carcinomas (HCCs) from metastases and hemangiomas by the amount of tumoral color signals. Intratumoral and peritumoral color signals were analyzed by a three-step grading system (grade 1 to 3) in 51 patients (32 HCCs, seven metastases, and 12 hemangiomas). Correlation of grading scores for intratumoral and peritumoral color signals was evaluated with the size of the tumors as well. HCCs demonstrated a higher grade of intratumoral color signals than did metastases or hemangiomas in all (p < 0.05) and biopsy-proved lesions (p = 0.0084); there was no significant difference in the degree of peritumoral color signals in all (p > 0.05) or 17 biopsy-proved HCCs (p = 0.2078) from the other tumor groups. In addition, the grade of both intratumoral and peritumoral color signals was not related with the tumor size in all groups (p > 0.05). In conclusion, color Doppler imaging provided a valuable role in the diagnosis of HCCs based on the qualitative analysis of the intratumoral color signals.