• Korean Journal of Radiology
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• 제25권3호
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• pp.243-256
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• 2024

Objective: We aimed to investigate whether 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[¹⁸F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[¹⁸F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[¹⁸F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

• Korean Journal of Radiology
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• 제24권8호
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• pp.729-738
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• 2023

Objective: When multiple surveillance mammograms are performed within an annual interval, the current guidance for oneyear follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses. Materials and Methods: We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up). Results: Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%. Conclusion: Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.

• Korean Journal of Radiology
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• 제24권9호
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• pp.860-870
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• 2023

Objective: The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI. Materials and Methods: This prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESS-WE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors. Results: The main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESS-WE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64-8.25] and 2.02 [95% CI: 0.32-12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19-16.75] and 1.94 [95% CI: 0.20-18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, P < 0.001). Conclusion: Preoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.

• 대한임상독성학회지
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• 제21권2호
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• pp.135-142
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• 2023

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027-1.844), 1.017 (95% CI, 1.002-1.032), and 0.196 (95% CI, 0.040-0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746-0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652-0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527-0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

• Korean Journal of Radiology
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• 제20권5호
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• pp.812-822
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• 2019

Objective: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. Materials and Methods: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). Results: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities (p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9-84.4% vs. 95.6-96.3%, p < 0.05; R2, 90.2-91.1% vs. 95.1-95.6%, p < 0.05) and specificity (R1, 68.3-72.9% vs. 92.7-95.8%, p < 0.005; R2, 83.0-85.4% vs. 97.6-98.0%, p = 0.07). Conclusion: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.

• Korean Journal of Radiology
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• 제21권6호
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• pp.736-745
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• 2020

Objective: To identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: Baseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge. Results: Thirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18-0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03-0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge. Conclusion: Lung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.

• 한국방사선학회논문지
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• 제11권5호
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• pp.379-385
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• 2017

본 논문은 디지털 엑스선 장비(DR)에서 사지 검사 시 환자 체형 변화에 따른 최적의 관전압을 알아보고자 하였다. 상지검사는 면적선량(DAP) $5.06dGy{\ast} cm^2$, 하지검사는 DAP $5.04dGy{\ast} cm^2$ 고정한 상태에서 관전압을 4단계 변화시키며 각 단계마다 3회씩 반복 촬영하였다. 환자의 체형의 변화를 주기 위해 10 mm 씩 총 30 mm까지 두께를 증가하였다. 정량적 평가를 위해 Image J를 이용하여 관전압에 따른 네 그룹간의 대조도 및 신호 대 잡음비 값을 산출하였고 통계학적 검정은 95% 신뢰수준에서 Kruskal-Wallis test로 유의한 차이를 분석하였다. 영상의 정성적 분석을 위하여 정해진 항목에 관해 5점 리커트 척도로 평가 하였다. 상지와 하지 실험 모두에서 관전압이 증가할수록 영상의 대조도대잡음비(CNR)과 신호대잡음비(SNR)이 감소하였으며, 환자의 체형에 따른 차이를 보기 위한 실험에서는 두께가 두꺼워 질수록 CNR과 SNR이 감소하였다. 정성적 평과는 상지는 관전압이 증가할수록 점수가 증가하여 최고 55 kV 에서 4.6, 40 kV 에서 3.6이였으며, 하지는 관전압의 상관없이 평균 4.4의 고른 점수가 나왔다. 상, 하지 모두 두께가 두꺼워지면서 점수는 전반적으로 낮아졌으나 상지는 40 kV에서는 점수가 급격히 낮아졌고, 하지에서는 50 kV에서는 점수가 급격히 낮아졌다. 표준 두께를 가지고 있는 환자의 경우 상지에서는 45 kV, 하지에서는 50 kV로 촬영하는 것이 최적화 된 영상을 구현할 수 있으며, 환자의 체형 두께가 증가하는 경우 상지는 50 kV, 하지는 55 kV로 관전압을 설정 하는 것이 효과적이다.

• 한국식품위생안전성학회지
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• 제26권2호
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• pp.142-149
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• 2011

본 연구에서는 면류에서 면역친화컬럼을 이용한 데옥시니발레놀의 HPLC분석법을 검증하고, 분석과정에서 발생될 수 있는 불확도를 GUM 지침에 따라 측정하였다. 검출한 계와 정량한계는 7.5 ${\mu}g$/kg과 18.8 ${\mu}g$/kg이었고 검량선은 20~500 ${\mu}g$/kg 농도범위 에서 0.9999의 높은 상관성을 보였다. 대표적인 밀 가공품인 건면과 라면에 데옥시니 발레놀을 200 ${\mu}g$/kg과 500 ${\mu}g$/kg을 첨가하여 회수율과 반복성올 측정한 결과, 건면에서는 $82{\pm}2.7%$와 $87{\pm}1.3%$의 결과를 얻었고, 라면에서는 $97{\pm}1.6%$와 $91{\pm}12.0%$로 측정되었다. 한편, 불확도 측정을 위한 첫 단계로, 분석과정에서의 불확도 요인은 시료량 측정, 최종 시료부피, 보관표준용액, 작업표준용액, 표준용액, 기기, 매질, 검량선 작성으로 구분하였다. 불확도 요인의 구성요인은 저울의 안정성, 분해능, 재현성, 표준물질의 순도, 분자량, 농도, 표준용액 희석, 검량선, 회수율 및 분석기기의 재현성 풍이 작용하였다. 건면과 라면에 데옥시니발레놀을 200과 500 ${\mu}g$/kg을 첨가하여 분석한 결과 건면에서는 $163.8{\pm}52.1\;{\mu}g$/kg, $435.2{\pm}91.6\;{\mu}g$/kg으로 측정되었고 라면에서는 $194.3{\pm}33.0\;{\mu}g$/kg, $453.2{\pm}91.1\;{\mu}g$/kg으로 측정되었다. 확장불확도는 합성표준불확도에 포함인자(k=2, 신뢰수준 95%)를 곱하여 산출하였다. 건면과 라면에서 데옥시니발레놀을 분석함에 있어 불확도에 영향을 주는 주요인자는 시료의 회수율과 검량선 작성인 것으로 파악되었다. 따라서 면류 시료에서 데옥시니발레놀 것으로 분석의 정밀성을 높이기 위해서는 회수율과 검량선 작성에 영향을 끼칠 수 있는 분석과정을 확인하고 오차를 최소화 할 수 있는 방안을 모색해야 할 것으로 사료된다.

• 대한치과보철학회지
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• 제50권4호
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• pp.299-304
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• 2012

연구 목적: 4,000 K와 5,500 K의 색 온도를 가진 광원 하에서 치과 보철과 의사 및 치과대학 학생의 색조 비교 및 선택 능력을 평가하여 술자의 경험이 색조 선택에 영향을 주는지를 알아보고자 한다. 연구 대상 및 방법: 분광 광도계를 사용하여 색 견본을 측색한 후, 명도 값이 비슷하고 채도 값이 차이 나는 5개 탭을 선택하여 3개의 세트(a, b, c)를, 채도값이 유사하고 명도값이 차이가 나는 5개 탭을 선택하여 3개의 세트(d, e, f)를 만들었다. 각각 4,000 K, 5,500 K 색 온도의 광원 하에서 무작위로 선택된 한 개의 색 견본을 치과 보철과 의사 10명과 치과대학 학생 10명에게 제시하고 동일한 색 견본을 동일한 세트 내에서 고르게 한 다음, 제시된 색조 탭과 피험자가 선택한 색조 탭 간의 색차(${\Delta}E$) 값을 계산하여 비색 능력의 차이를 비교하였다. 광원의 색 온도 및 술자의 숙련도에 따른, 각각의 색 견본에서의 색차 값을 계산하고 95%의 신뢰 수준에서 t-test 를 시행하여 결과의 유의성을 검정하였다. 결과: 4,000K와 5,500K 광원 하에서 색차 값은 각각 $1.62{\pm}2.0$, $1.33{\pm}1.7$로 색 온도 조건에 따른 색조 선택의 차이는 나타나지 않았다(P=.398). 숙련자군과 비 숙련자군 간의 색차 값은 각각 $1.34{\pm}1.7$, $1.61{\pm}2.0$으로 각 군 간 색조 선택의 차이 또한 나타나지 않았다(P=.221). 결론: 동일한 색 견본을 동일한 광원 조건 하에서 비색하는 경우, 술자의 숙련도에 따른 색조 선택 능력에 차이가 없다.

• 분석과학
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• 제26권3호
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• pp.165-173
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• 2013

본 연구는 실내공기질 분야에 대한 합리적인 숙련도 시험 프로그램 확립을 위해 기체상 표준 물질을 제조하고, 시료 채취 과정을 포함한 숙련도 평가가 타당한 것인지 여부를 검토하였다. 또한 숙련도시료(PTMs; proficiency testing materials)의 균질성 및 안정성 평가를 실시하였다. PTMs의 모든 항목에 대해 시료간 균질도가 $0.3{\sigma}p$ 값보다 낮은 값을 가지는 것으로 나타나 충분히 균질성이 확보 되었다고 판단할 수 있었다. 숙련도 평가를 실시한 결과 고압의 실린더에 제조된 VOCs (volatile organic compounds) 표준가스를 Tenax-TA에 흡착시켜 분배한 시료(A 방법)는 시료농도 50~320 ${\mu}g/m^3$에서 로버스트 상대표준편차(RSD)가 23~43% 이내로 나타났고, 시료채취 과정에 대한 숙련도 시험 포함 여부를 평가하기 위하여 고압의 실린더에 제조된 VOCs 표준가스를 기체상으로 테들라백에 담아 분배한 시료(B 방법)와 고압의 실린더에 제조된 VOCs 표준가스를 분배기를 통하여 시험기관이 직접 흡착관에 채취하게 한 시료(C 방법)는 자일렌을 제외하고, VOCs 각각의 농도 200~1200 ${\mu}g/m^3$, 100~450 ${\mu}g/m^3$에서 로버스트 상대표준편차(RSD)가 각각 13~42%, 16~31% 이내로 나타나 시료채취 과정을 포함한 경우 오히려 낮은 상대표준편차를 보였다. 이상의 결과로 볼 때 지속적으로 시료 채취 과정을 포함한 숙련도 평가를 실시하여도 타당할 것으로 사료된다.