• Korean Journal of Radiology
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• 제22권7호
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• pp.1066-1076
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• 2021

Objective: To evaluate the performance of the 2018 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) Practice Guidelines (hereafter, PG) for the diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI, compared to the Liver Imaging-Reporting and Data System (LI-RADS) version 2018 (hereafter, v2018). Materials and Methods: From January 2013 to October 2015, treatment-naïve hepatic lesions (≥ 1 cm) on gadoxetic acid-enhanced MRI in consecutive patients with chronic hepatitis B or cirrhosis were retrospectively evaluated. For each lesion, three radiologists independently analyzed the imaging features and classified the lesions into categories according to the 2018 KLCA-NCC PG and LI-RADS v2018. The imaging features and categories were determined by consensus. Generalized estimating equation (GEE) models were used to compare the per-lesion diagnostic performance of the 2018 KLCA-NCC PG and LI-RADS v2018 using the consensus data. Results: In total, 422 lesions (234 HCCs, 45 non-HCC malignancies, and 143 benign lesions) from 387 patients (79% male; mean age, 59 years) were included. In all lesions, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity and lower specificity than LR-5 (LI-RADS v2018) (87.2% [204/234] vs. 80.8% [189/234], p < 0.001; 86.2% [162/188] vs. 91.0% [171/188], p = 0.002). However, in lesions of size ≥ 2 cm, the definite HCC had a higher sensitivity than the LR-5 (86.8% [164/189] vs. 82.0 (155/189), p = 0.002) without a reduction in the specificity (80.0% [48/60] vs. 83.3% [50/60], p = 0.15). In all lesions, the sensitivity and specificity of the definite/probable HCC (2018 KLCA-NCC PG) and LR-5/4 did not differ significantly (89.7% [210/234] vs. 91.5% [214/234], p = 0.204; 83.5% [157/188] vs. 79.3% [149/188], p = 0.071). Conclusion: For the diagnosis of HCC of size ≥ 2 cm, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity than LR-5, without a reduction in specificity. The definite/probable HCC (2018 KLCA-NCC PG) had a similar sensitivity and specificity to that those of the LR-5/4.

• Korean Journal of Radiology
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• 제22권4호
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• pp.559-567
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• 2021

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

• Korean Journal of Radiology
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• 제24권5호
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• pp.434-443
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• 2023

Objective: To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery for proximal femur fractures. Materials and Methods: We retrospectively identified consecutive patients aged ≥ 65 years who underwent pelvic bone CT and subsequent surgery for proximal femur fractures between July 2018 and September 2021. Eight CT metrics were calculated from the cross-sectional area and attenuation of the subcutaneous fat and muscle, including the thigh subcutaneous fat (TSF) index, TSF attenuation, thigh muscle (TM) index, TM attenuation, gluteus maximus (GM) index, GM attenuation, gluteus medius and minimus (Gmm) index, and Gmm attenuation. The patients were dichotomized using the median value of each metric. Multivariable Cox regression and logistic regression models were used to determine the association between CT metrics with overall survival (OS) and postsurgical intensive care unit (ICU) admission, respectively. Results: A total of 372 patients (median age, 80.5 years; interquartile range, 76.0-85.0 years; 285 females) were included. TSF attenuation above the median (adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.41-4.05), GM index below the median (adjusted HR, 2.63; 95% CI, 1.33-5.26), and Gmm index below the median (adjusted HR, 2.33; 95% CI, 1.12-4.55) were independently associated with shorter OS. TSF index (adjusted odds ratio [OR], 6.67; 95% CI, 3.13-14.29), GM index (adjusted OR, 3.45; 95% CI, 1.49-7.69), GM attenuation (adjusted OR, 2.33; 95% CI, 1.02-5.56), Gmm index (adjusted OR, 2.70; 95% CI, 1.22-5.88), and Gmm attenuation (adjusted OR, 2.22; 95% CI, 1.01-5.00) below the median were independently associated with ICU admission. Conclusion: In older adult patients who underwent surgery for proximal femur fracture, low muscle indices of the GM and gluteus medius/minimus obtained from their cross-sectional areas on preoperative pelvic bone CT were significant prognostic markers for predicting high mortality and postsurgical ICU admission.

• Korean Journal of Radiology
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• 제24권2호
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• pp.133-144
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• 2023

Objective: Cyclin-dependent kinase inhibitor (CDKN)2A/B homozygous deletion is a key molecular marker of isocitrate dehydrogenase (IDH)-mutant astrocytomas in the 2021 World Health Organization. We aimed to investigate whether qualitative and quantitative MRI parameters can predict CDKN2A/B homozygous deletion status in IDH-mutant astrocytomas. Materials and Methods: Preoperative MRI data of 88 patients (mean age ± standard deviation, 42.0 ± 11.9 years; 40 females and 48 males) with IDH-mutant astrocytomas (76 without and 12 with CDKN2A/B homozygous deletion) from two institutions were included. A qualitative imaging assessment was performed. Mean apparent diffusion coefficient (ADC), 5th percentile of ADC, mean normalized cerebral blood volume (nCBV), and 95th percentile of nCBV were assessed via automatic tumor segmentation. Logistic regression was performed to determine the factors associated with CDKN2A/B homozygous deletion in all 88 patients and a subgroup of 47 patients with histological grades 3 and 4. The discrimination performance of the logistic regression models was evaluated using the area under the receiver operating characteristic curve (AUC). Results: In multivariable analysis of all patients, infiltrative pattern (odds ratio [OR] = 4.25, p = 0.034), maximal diameter (OR = 1.07, p = 0.013), and 95th percentile of nCBV (OR = 1.34, p = 0.049) were independent predictors of CDKN2A/B homozygous deletion. The AUC, accuracy, sensitivity, and specificity of the corresponding model were 0.83 (95% confidence interval [CI], 0.72-0.91), 90.4%, 83.3%, and 75.0%, respectively. On multivariable analysis of the subgroup with histological grades 3 and 4, infiltrative pattern (OR = 10.39, p = 0.012) and 95th percentile of nCBV (OR = 1.24, p = 0.047) were independent predictors of CDKN2A/B homozygous deletion, with an AUC accuracy, sensitivity, and specificity of the corresponding model of 0.76 (95% CI, 0.60-0.88), 87.8%, 80.0%, and 58.1%, respectively. Conclusion: The presence of an infiltrative pattern, larger maximal diameter, and higher 95th percentile of the nCBV may be useful MRI biomarkers for CDKN2A/B homozygous deletion in IDH-mutant astrocytomas.

• Korean Journal of Radiology
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• 제23권12호
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• pp.1269-1280
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• 2022

Objective: This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD). Materials and Methods: We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters. Results: Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11-117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81; p = 0.034) and LS-VR (sHR, 0.71; p = 0.01) were independently associated with hepatic decompensation. The ΔLS-VR (sHR, 0.54; p = 0.002) was predictive of hepatic decompensation after adjusting for baseline variables. ΔLS-VR was an independent predictor of liver-related death or transplantation in patients with compensated ACLD (sHR, 0.46; p = 0.026) and decompensated ACLD (sHR, 0.61; p = 0.023). Conclusion: MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.

• Annals of Occupational and Environmental Medicine
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• 제35권
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• pp.9.1-9.10
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• 2023

Background: Studies conducted so far on the link between commute time and mental health among Koreans remain insufficient. In this study, we attempted to identify the relationship between commute time and subjective mental health using the 6^th Korean Working Conditions Survey (KWCS). Methods: Self-reported commute time was divided into four groups: ≤ 30 (group 1), 30-60 (group 2), 60-120 (group 3), and > 120 minutes (group 4). Subjective depression was defined as a score of 50 points or less on the WHO-5 well-being index. Subjective anxiety and fatigue were defined as answering 'yes' to the questionnaire on whether they had experienced it over the past year. The analysis of variance, t-test, and χ² test was used to analyze the differences among the characteristics of the study participants according to commute time, depression, anxiety, and fatigue. Odds ratios (ORs) and 95% confidence intervals (CIs) for depression, anxiety, and fatigue according to commute time were calculated using multivariate logistic regression models adjusted for sex, age, monthly income, occupation, company size, weekly working hours, and shift work status. Results: Long commute times showed increased ORs and graded increasing trends for depression, anxiety, and fatigue. The ORs for depression increased significantly in group 2 (1.06 [1.01-1.11]), group 3 (1.23 [1.13-1.33]), and group 4 (1.31 [1.09-1.57]) compared to group 1 (reference). The ORs for anxiety increased significantly in group 2 (1.17 [1.06-1.29]), group 3 (1.43 [1.23-1.65]) and group 4 (1.89 [1.42-2.53]). The ORs for fatigue increased significantly in group 2 (1.09 [1.04-1.15]), group 3 (1.32 [1.21-1.43]), and group 4 (1.51 [1.25-1.82]). Conclusions: This study highlights that the risk of depression, anxiety, and fatigue increases with commute time.

• Korean Journal of Radiology
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• 제21권9호
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• pp.1065-1076
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• 2020

Objective: To determine the prognostic value of MRI-based tumor regression grading (mrTRG) in rectal cancer compared with pathological tumor regression grading (pTRG), and to assess the effect of diffusion-weighted imaging (DWI) on interobserver agreement for evaluating mrTRG. Materials and Methods: Between 2007 and 2016, we retrospectively enrolled 321 patients (male:female = 208:113; mean age, 60.2 years) with rectal cancer who underwent both pre-chemoradiotherapy (CRT) and post-CRT MRI. Two radiologists independently determined mrTRG using a 5-point grading system with and without DWI in a one-month interval. Two pathologists graded pTRG using a 5-point grading system in consensus. Kaplan-Meier estimation and Cox-proportional hazard models were used for survival analysis. Cohen's kappa analysis was used to determine interobserver agreement. Results: According to mrTRG on MRI with DWI, there were 6 mrTRG 1, 48 mrTRG 2, 109 mrTRG 3, 152 mrTRG 4, and 6 mrTRG 5. By pTRG, there were 7 pTRG 1, 59 pTRG 2, 180 pTRG 3, 73 pTRG 4, and 2 pTRG 5. A 5-year overall survival (OS) was significantly different according to the 5-point grading mrTRG (p = 0.024) and pTRG (p = 0.038). The 5-year disease-free survival (DFS) was significantly different among the five mrTRG groups (p = 0.039), but not among the five pTRG groups (p = 0.072). OS and DFS were significantly different according to post-CRT MR variables: extramural venous invasion after CRT (hazard ratio = 2.259 for OS, hazard ratio = 5.011 for DFS) and extramesorectal lymph node (hazard ratio = 2.610 for DFS). For mrTRG, k value between the two radiologists was 0.309 (fair agreement) without DWI and slightly improved to 0.376 with DWI. Conclusion: mrTRG may predict OS and DFS comparably or even better compared to pTRG. The addition of DWI on T2-weighted MRI may improve interobserver agreement on mrTRG.

• Annals of Occupational and Environmental Medicine
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• 제34권
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• pp.15.1-15.9
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• 2022

Background: Most previous longitudinal studies on lifestyle and gastroesophageal reflux disease (GERD) have focused on physical activity rather than sitting time. The main purpose of this study was to investigate the relationship between prolonged sitting time and the development of erosive esophagitis (EE). Methods: A self-report questionnaire was used for measuring sitting time in the Kangbuk Samsung Health Study. Sitting time was categorized into four groups: ≤ 6, 7-8, 9-10, and ≥ 11 hours/day. Esophagogastroduodenoscopy (EGD) was performed by experienced endoscopists who were unawared of the aims of this study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of EE were estimated using Cox proportional hazards analyses with ≤ 6 hours/day sitting time as the reference. Results: There were 6,524 participants included in the study. During a mean follow-up of 3.14 years, 2,048 incident cases developed EE. In age- and sex-adjusted models, the HR in the group sitting ≥ 11 hours per day compared ≤ 6 hours per day was 0.88 (95% CI: 0.76-0.99). After further adjusting for alcohol intake, smoking status, educational level, history of diabetes, and history of dyslipidemia, sitting time was still significantly related to the risk of EE (HR, 0.87; 95% CI: 0.76-0.98). After further adjustment for exercise frequency, this association persisted (HR, 0.86; 95% CI: 0.76-0.98). In subgroup analysis by obesity, the relationship between sitting time and EE was only significant among participants with body mass index < 25 kg/m² (HR, 0.82; 95% CI: 0.71-0.95). Conclusions: Generally, prolonged sitting time is harmful to health, but with regard to EE, it is difficult to conclude that this is the case.

• 만화애니메이션 연구
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• 통권33호
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• pp.597-616
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• 2013

캐릭터산업은 저작권리를 중심으로 한 지식기반산업이면서 제조업과 서비스업의 판매가치를 촉진시키고 매출효과를 강화하는 보완재적 산업특성을 지니고 있어서 전 산업분야에 걸쳐 기능적으로 작동될 수 있는 창조경제의 핵심동력이다. 2003년부터 시작된 정부의 캐릭터관련 정책은 연관산업간의 연계효과 극대화, 국내 캐릭터의 해외진출확대, 유통구조 개선을 통한 저작권 강화, 캐릭터상품의 질적강화를 통한 산업기반 확대 등에 중점을 두었다. 이러한 정책성과로 인해, 2007년 이후, 연관콘텐츠의 성공사례가 구체화되기 시작했고, 국내외 캐릭터산업은 보다 체계적인 진화과정을 거치게 된다. 창작캐릭터의 자체적인 산업육성 노하우가 축적되고, 만화, 애니메이션, 게임, 소설, 영화, 뮤지컬 등으로 시작된 연관캐릭터가 시장세분화전략에 의해 활성화되면서 캐릭터산업의 범위 및 산업적 통계의 재설정이 요구되기 시작했다. 특히, 2009년 이후 정부는 '세계 5대 캐릭터 강국'으로의 목표를 설정하고, 글로벌 스타캐릭터 발굴, 연관산업간 네트워크 구축지원, 홍보채널 다양화 및 프로모션 강화, 라이선싱 비즈니스 활성화 등의 정책을 발굴하게 된다. 특히, 2013년을 기점으로 캐릭터를 활용한 캐릭터 체험전 등의 전시시장, 키즈카페 등의 시간관리형 캐릭터 실내테마파크, SNS의 이모티콘을 중심으로 한 디지털캐릭터 수요시장, 캐릭터 뮤지컬을 중심으로 한 공연시장 등 새로운 캐릭터시장이 지속적으로 개발되고, 기존 오프라인의 불법복제시장이 국내외적으로 대형화되면서 그에 따른 체계적인 정책대안이 필요하게 되었다. 진화하는 캐릭터 소비시장과 플랫폼 다양화 시대에 대응하여, 캐릭터산업을 활성화시키고 새로운 캐릭터디자인 및 관련 콘텐츠를 지원하기 위해서는 캐릭터산업의 정책변인을 전제로 한 전략방향의 입체적 설정이 요구된다. 지난 정부의 정책성과와 국내외 캐릭터산업의 시장현황, 그리고 진화방향을 분석하여 정책변인을 구체화시키면 다음과 같다. 현재 국내캐릭터산업의 정책변인은 플랫폼 다양화에 따른 디지털 캐릭터시장의 소비다층화, 한류중심의 캐릭터상품 융합콘텐츠화, 불법콘텐츠의 지하경제 양성화, 세분화된 시장의 수용자 편향성관리 등으로 분석되며, 이는 미국과 일본 및 유럽의 기존 캐릭터산업 강국들과는 다른 차원의 정책이슈를 발굴하게 된다. 결국 국내외시장의 연관콘텐츠 저작권계약 모델개발, 플랫폼 경제의 수익모델 다각화, 한류확대에 연계된 목표시장 추가개발, 평생캐릭터의 연령별 맞춤형 시장전략 등이 캐릭터 수요시장진화에 따른 대안으로 제시된다.

• 지능정보연구
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• 제17권4호
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• pp.95-108
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• 2011

인터넷 비즈니스의 활성화에 따라서 기업은 고객의 인물정보 및 거래정보를 활용하여 보다 맞춤화된 개인화 서비스를 제공하고 있다. 기존의 고객군별 예측기법은 유사한 고객들을 군집화하여 고객군별로 예측모델을 수립하는 것으로, 구매가 많고 충성도가 높은 핵심고객에게 요구되는 일대일 서비스를 제공하는 데는 한계가 있다. 반면 일대일 고객별 예측기법은 각 고객에게 고도로 맞춤화된 서비스를 제공하지만, 과거 구매이력이 많지 않은 고객 이나 신규 고객에게는 정확한 개인화 서비스를 제공하지 못한다. 본 연구는 고객의 구매빈도에 따라서 유사 고객들과의 군집화 수준을 동적으로 조정하는 새로운 지능형 개인화 시스템을 제안한다. 제안된 시스템은 과거 구매가 많은 고객들에 대해서는 일대일 예측모델을 수립하지만, 구매 빈도가 낮은 고객의 경우 다른 고객들과의 최적화된 군집화를 통해 예측모델을 수립한다. 본 기법을 Neilsen의 음료수 구매 데이터셋에 적용하여 고객의 일회 구매금액 및 구매품목을 예측한 결과, 기존 두 예측기법들에 비하여 적정한 계산비용(computational cost)으로 더욱 정확한 개안화 서비스를 제공할 수 있음을 확인하였다.