• Korean Journal of Radiology
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• 제24권10호
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• pp.1006-1016
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• 2023

Objective: Computed tomography (CT) is an established method for the diagnosis, staging, and treatment of multiple myeloma. Here, we investigated the potential of photon-counting detector computed tomography (PCD-CT) in terms of image quality, diagnostic confidence, and radiation dose compared with energy-integrating detector CT (EID-CT). Materials and Methods: In this prospective study, patients with known multiple myeloma underwent clinically indicated whole-body PCD-CT. The image quality of PCD-CT was assessed qualitatively by three independent radiologists for overall image quality, edge sharpness, image noise, lesion conspicuity, and diagnostic confidence using a 5-point Likert scale (5 = excellent), and quantitatively for signal homogeneity using the coefficient of variation (CV) of Hounsfield Units (HU) values and modulation transfer function (MTF) via the full width at half maximum (FWHM) in the frequency space. The results were compared with those of the current clinical standard EID-CT protocols as controls. Additionally, the radiation dose (CTDIvol) was determined. Results: We enrolled 35 patients with multiple myeloma (mean age 69.8 ± 9.1 years; 18 [51%] males). Qualitative image analysis revealed superior scores (median [interquartile range]) for PCD-CT regarding overall image quality (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), edge sharpness (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), image noise (4.0 [4.0-4.0] vs. 3.0 [3.0-4.0]), lesion conspicuity (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), and diagnostic confidence (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]) compared with EID-CT (P ≤ 0.004). In quantitative image analyses, PCD-CT compared with EID-CT revealed a substantially lower FWHM (2.89 vs. 25.68 cy/pixel) and a significantly more homogeneous signal (mean CV ± standard deviation [SD], 0.99 ± 0.65 vs. 1.66 ± 0.5; P < 0.001) at a significantly lower radiation dose (mean CTDIvol ± SD, 3.33 ± 0.82 vs. 7.19 ± 3.57 mGy; P < 0.001). Conclusion: Whole-body PCD-CT provides significantly higher subjective and objective image quality at significantly reduced radiation doses than the current clinical standard EID-CT protocols, along with readily available multi-spectral data, facilitating the potential for further advanced post-processing.

• Journal of Chest Surgery
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• 제54권5호
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• pp.433-435
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• 2021

Pleural adhesions are a major challenge in standard and nonintubated video-assisted thoracic surgery. The currently available imaging techniques help to assess the presence and extent of pleural adhesions, but do not provide information on tissue deformability, which is crucial for intraoperative management. In this report, we describe the utilization of real-time elastography mapping of pleural adhesions. This technique enabled us to detect areas with softer adhesions, and helped establish the surgical plan in a difficult case of a patient scheduled for nonintubated video-assisted thoracic surgery.

• 대한영상의학회지
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• 제84권4호
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• pp.784-791
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• 2023

국내의 각종 통계에 따르면 외상센터는 외상 환자 치료에 중심적이며 확고한 역할을 담당하고 있는 것으로 나타났다. 외상센터에서 인터벤션 영상의학자의 역할은 출혈이 멈추도록 하는 것이다. 기본적인 색전술이 치료의 근간을 이루지만 스텐트 그래프트 설치술 등이 사용되기도 한다. 전통적인 응급인터벤션시술이 사용되어 왔으나 외상 환자에게는 짧은 시간 내에 효율적으로 출혈을 막는 것이 필수적이다. 따라서, 최근 부각되고 있는 손상통제인터벤션영상의학의 개념을 정확히 인지하고 실행하는 것이 예방 가능 외상 사망률을 낮추는데 매우 중요하다.

• 대한영상의학회지
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• 제84권4호
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• pp.824-834
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• 2023

외상성 복부 장기 손상 환자의 치료에서 비수술적 치료의 비중이 증가하고 있으며, 이는 혈관 내 인터벤션 치료의 발전과 보편화와 연관이 있다. 최근 American Association for the Surgery of Trauma (AAST)의 Organ Injury Scaling System과 World Society of Emergency Surgery (WSES)에서 간, 비장, 신장 외상 진료 및 치료에 대한 가이드라인을 발표하였고, 인터벤션 치료의 역할을 명확히 제시하였다. 이를 바탕으로 인터벤션 영상의학의 관점에서 외상 환자 치료에 참여하면서 기본적으로 알고 있어야 할 내용 및 각 장기별 인터벤션 치료시 고려할 사항에 대해 알아보고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6135-6140
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• 2015

Background: The aim of this meta-analysis was to assess the efficacy of the apparent diffusion coefficient (ADC) value of diffusion-weighted MRI (DWI) for differentiating biliary tract cancer (BTC) from benign biliary tract diseases in Asians. Materials and Methods: We systematically searched Embase and PubMed prior to December 2014. Eight studies conducted in Asians met our predetermined inclusion criteria. Results: Our meta-analysis results showed that ADC values in BTC tissues were significantly lower than in benign biliary tract tissues (SMD = -1.54, 95%CI: -1.75~-1.33, P<0.001). Subgroup analysis based on the MRI machine type showed that the ADC values were consistent, accurate and reliable in the diagnosis of BTC when comparing cancer tissue vs. benign tissue under the Siemens 1.5 T/3.0 T, Philips 1.5 T/3.0 T, GE 1.5 T, and Toshiba 1.5 T types, respectively (all P<0.05). Further, ADC values were still consistent and accurate in the differential diagnosis of BTC under the b value of 800 and $1000s/mm^2$ (all P<0.05). Conclusions: Our findings supported potential clinical applications of DWI ADC values in differentiating BTC from benign biliary tract diseases in Asians.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.703-706
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• 2014

Objective: To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) before major hepatectomy for patients with hepatocellur carcinoma (HCC). Methods: In this retrospective case-control study, data were collected from patients who underwent sequential TACE and PVE prior to major hemihepactectomy. Liver volumes were measured by computed tomography volumetry before TACE, and preoperation to assess degree of future remnant liver (FRL) hypertrophy and to check whether intro- or extrohepatic metastasis existed. Liver function was monitored by biochemistry after TACE, prior to and after major hepatectomy. Results: Mean average FRL volume increased 32.3-71.4% (mean 55.4%) compared with preoperative FRL volume. After TACE, liver enzymes were elevated, but returned to normal in four weeks. During PVE and resection, no patient had intro- or extrohepatic metastasis. Conclusion: Sequential TACE and PVE is an effective method to improve resection opportunity, expand the scope of surgical resection, and greatly reduce postoperative intra- and extrahepatic metastasis.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.523-530
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• 2022

Objective : To evaluate the safety and efficacy of an overlapped stenting-assisted coiling technique in treating vertebral artery dissecting aneurysm (VADA) via Low-profile Visualized Intraluminal Support (LVIS) stent-within-Neuroform EZ stent. Methods : From January 2017 to June 2019, 18 consecutive patients with VADAs (ruptured : unruptured=5 : 13) were treated with the overlapping stents assisted-coiling technique in our center. The overlapping manner was a Neuroform EZ stent being deployed first, followed by LVIS stents placement using the 'shelf' technique. The patients' clinical characteristics, technical feasibility and safety, and immediate and follow-up angiographic results were retrospectively reviewed. Results : Seventeen (94.4%) procedures were technically successful with an exact deployment of the stents and patent parent or perforator arteries. The immediate angiographies after procedure confirmed Raymond class I, II, and III occlusion of VADAs were in 12 (66.7%), two (11.1%), and four cases (22.2%), respectively. Post-procedural complications developed in one patient (5.6%) with minor brainstem infarctions, which resulted from an in-stent thrombosis during the procedure. Angiographic follow-up at 5.7 months (range 3 to 9 months) demonstrated Raymond class I and II occlusion were in all cases (100%). The modified Rankin Scale scores at 21.3 months (range 15 to 42 months) 0-2 in 17 cases (94.4%) and three in one case (5.6%). Conclusion : Overlapping stents via LVIS stent-within-Neuroform EZ stent combined with coiling is safe and effective for patients with VADA in the midterm results.

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5527-5531
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• 2013

Background and Aim: Increasing evidence correlates the presence of systemic inflammation with poor survival in patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate the prognostic significance of the blood neutrophil-to-lymphocyte ratio (NLR) in patients with advanced HCC who received sorafenib monotherapy. Methods: A total of sixty-five patients with advanced HCC, not eligible for locoregional therapy, treated with sorafenib were enrolled. Potential prognostic factors such as age, gender, tumoral characteristics, performance status and NLR were analyzed. Results: Median OS and TTP for the entire cohort were 10.0 months (95%CI, 7.6-12.3 months) and 4.5 months (95% CI, 4.0-4.9 months). The mean NLR at baseline was 2.89. The median OS of patients with a high NLR (>4) was 6.5 months (95%CI, 5.2-7.7 months) compared with 12.5 months (95%CI, 9.9-15.0) for patients with a normal NLR (${\leq}4$) (P=0.01). Age ${\leq}65$, NLR>4, extrahepatic metastases and vascular invasion were all predictors of poorer overall survival. Multivariate analysis showed that NLR > 4, vascular invasion and extrahepatic metastases were independent predictors of poorer overall survival. The median TTP of patients with a high NLR was 2.5 months (95%CI, 1.4-3.6 months) compared with 4.5 months (95%CI, 3.9-5.1 months) for patients with a normal NLR (P=0.012). Conclusions: High baseline NLR was associated with worse OS and TTP for patients with advanced HCC treated with sorafenib.

• Journal of Radiation Protection and Research
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• 제49권2호
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• pp.78-84
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• 2024

Background: As the quantity and complexity of radiological interventions are constantly increasing, gear that offers optimal protection while maintaining mobility and a low weight burden is becoming more important. A newly developed exoskeleton radiation protection system (ERPS) (StemRad MD; StemRad Ltd.) can carry the weight of the shielding. The aim of our study was to analyze initial experience, especially in terms of advantages and disadvantages, with this new ERPS in interventional radiology. Materials and Methods: Forty-six interventions utilizing the ERPS were analyzed. The interventional radiologists completed a 15-question survey evaluating various aspects of the protective system, including weight, mobility, comfort, and radiation protection adequacy. Results and Discussion: In 98% of procedures, interventionalists reported being very satisfied (89%) or slightly satisfied (9%) and would recommend the system to colleagues. The exoskeleton system was rated as 100% comfortable, not too heavy, and did not restrict mobility in 98% of cases. Conclusion: The ERPS is a recommendable alternative to standard lead aprons, providing flexibility, comfort, and effective weight distribution without restricting mobility.

• Korean Journal of Radiology
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• 제20권6호
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• pp.939-946
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• 2019

Objective: To report our initial experience of percutaneous sacroplasty (PSP) with an interpedicular approach for treating painful sacral metastases involving multiple sacral vertebral bodies. Materials and Methods: This study prospectively enrolled 10 consecutive patients (six men and four women; mean age, 56.3 ± 13.8 years) who underwent PSP for painful sacral metastases involving multiple sacral vertebral bodies from March 2017 to September 2018. Visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and the number of opioids prescribed to the patients were assessed before and after PSP. The procedure duration, length of hospitalization, and complications were also recorded. Results: Mean VAS and ODI declined significantly from 6.90 ± 1.20 and 74.40 ± 5.48 before the procedure to 2.70 ± 1.34 and 29.60 ± 14.57 after the procedure, respectively (p < 0.01). The median number of opioids prescribed per patient decreased from 2 (interquartile range [IQR] 1-3) pre-procedure to 1 (IQR 0-3) post-procedure (p < 0.01). Nine of the 10 patients showed no or decreased opioid usage, and only 1 patient showed unchanged usage. The mean procedure duration was 48.5 ± 3.0 minutes. The average length of hospitalization was 4.7 ± 1.7 days. Extraosseous cement leakage occurred in three cases without causing any clinical complications. Conclusion: PSP with an interpedicular approach is a safe and effective treatment in patients with painful sacral metastases involving multiple sacral vertebral bodies and can relieve pain and improve mobility.