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Prediction of Cognitive Progression in Individuals with Mild Cognitive Impairment Using Radiomics as an Improvement of the ATN System: A Five-Year Follow-Up Study

  • Rao Song;Xiaojia Wu;Huan Liu;Dajing Guo;Lin Tang;Wei Zhang;Junbang Feng;Chuanming Li
    • Korean Journal of Radiology
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    • v.23 no.1
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    • pp.89-100
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    • 2022
  • Objective: To improve the N biomarker in the amyloid/tau/neurodegeneration system by radiomics and study its value for predicting cognitive progression in individuals with mild cognitive impairment (MCI). Materials and Methods: A group of 147 healthy controls (HCs) (72 male; mean age ± standard deviation, 73.7 ± 6.3 years), 197 patients with MCI (114 male; 72.2 ± 7.1 years), and 128 patients with Alzheimer's disease (AD) (74 male; 73.7 ± 8.4 years) were included. Optimal A, T, and N biomarkers for discriminating HC and AD were selected using receiver operating characteristic (ROC) curve analysis. A radiomics model containing comprehensive information of the whole cerebral cortex and deep nuclei was established to create a new N biomarker. Cerebrospinal fluid (CSF) biomarkers were evaluated to determine the optimal A or T biomarkers. All MCI patients were followed up until AD conversion or for at least 60 months. The predictive value of A, T, and the radiomics-based N biomarker for cognitive progression of MCI to AD were analyzed using Kaplan-Meier estimates and the log-rank test. Results: The radiomics-based N biomarker showed an ROC curve area of 0.998 for discriminating between AD and HC. CSF Aβ42 and p-tau proteins were identified as the optimal A and T biomarkers, respectively. For MCI patients on the Alzheimer's continuum, isolated A+ was an indicator of cognitive stability, while abnormalities of T and N, separately or simultaneously, indicated a high risk of progression. For MCI patients with suspected non-Alzheimer's disease pathophysiology, isolated T+ indicated cognitive stability, while the appearance of the radiomics-based N+ indicated a high risk of progression to AD. Conclusion: We proposed a new radiomics-based improved N biomarker that could help identify patients with MCI who are at a higher risk for cognitive progression. In addition, we clarified the value of a single A/T/N biomarker for predicting the cognitive progression of MCI.

Percutaneous Biliary Metallic Stent Insertion in Patients with Malignant Duodenobiliary Obstruction: Outcomes and Factors Influencing Biliary Stent Patency

  • Ji Hye Kwon;Dong Il Gwon;Jong Woo Kim;Hee Ho Chu;Jin Hyoung Kim;Gi-Young Ko;Hyun-Ki Yoon;Kyu-Bo Sung
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.695-706
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    • 2020
  • Objective: To investigate the technical and clinical efficacy of the percutaneous insertion of a biliary metallic stent, and to identify the factors associated with biliary stent dysfunction in patients with malignant duodenobiliary obstruction. Materials and Methods: The medical records of 70 patients (39 men and 31 women; mean age, 63 years; range, 38-90 years) who were treated for malignant duodenobiliary obstruction at our institution between April 2007 and December 2018, were retrospectively reviewed. Variables found significant by univariate log-rank analysis (p < 0.2) were considered as suitable candidates for a multiple Cox's proportional hazard model. Results: The biliary stents were successfully placed in all 70 study patients. Biliary stent insertion with subsequent duodenal stent insertion was performed in 33 patients and duodenal stent insertion with subsequent biliary stent insertion was performed in the other 37 study subjects. The median patient survival and stent patency time were 107 days (95% confidence interval [CI], 78-135 days) and 270 days (95% CI, 95-444 days), respectively. Biliary stent dysfunction was observed in 24 (34.3%) cases. Multiple Cox's proportional hazard analysis revealed that the location of the distal biliary stent was the only independent factor affecting biliary stent patency (hazard ratio, 3.771; 95% CI, 1.157-12.283). The median biliary stent patency was significantly longer in patients in whom the distal end of the biliary stent was beyond the distal end of the duodenal stent (median, 327 days; 95% CI, 249-450 days), rather than within the duodenal stent (median, 170 days; 95% CI, 115-225 days). Conclusion: The percutaneous insertion of the biliary metallic stent appears to be a technically feasible, safe, and effective method of treating malignant duodenobiliary obstruction. In addition, a biliary stent system with a distal end located beyond the distal end of the duodenal stent will contribute towards longer stent patency in these patients.

Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis

  • Tae-Seok Kim;Kwangho Yang;Gi Hong Choi;Hye Yeon Yang;Dong-Sik Kim;Hye-Sung Jo;Gyu-Seong Choi;Kwan Woo Kim;Young Chul Yoon;Jaryung Han;Doo Jin Kim;Shin Hwang;Koo Jeong Kang
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.2
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    • pp.134-143
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    • 2024
  • Backgrounds/Aims: The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT. Methods: We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea. Results: The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA-II, neutrophil-to-lymphocyte ratio, and albumin-bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors-tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, p < 0.001). Conclusions: HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.

Prognostic Relevance of WHO Classification and Masaoka Stage in Thymoma (흉선종양에서의 WHO 분류와 Masaoka 병기, 임상양상간의 상관관계연구)

  • Kang Seong Sik;Chun Mi Sun;Kim Yong Hee;Park Seung Il;Eeom Dae W.;Ro Jaee Y.;Kim Dong Kwan
    • Journal of Chest Surgery
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    • v.38 no.1 s.246
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    • pp.44-49
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    • 2005
  • Although thymomas are relatively common mediastinal tumors, to date not only has a universal system of pathologic classification not been established but neither has a clearly defined predictable relationship between treatment and prognosis been made. Recently, a new guideline for classification was reported by WHO, and efforts, based on this work, have been made to better define the relationship between treatment and pro­gnostic outcome. In the present study a comparative analysis between the WHO classification and Masaoka stage system with the clinical disease pattern was conducted. Material and Method: A total of 98 patients undergoing complete resection for mediastinal thymoma between Juanuary 1993 and June 2003 were included in the present study. The male female ratio was 48 : 50 and the mean age at operation was $49.6{\pm}13.9\;years.$ A retrospective analytic comparison studying the relationship between the WHO classification and the Masaoka stage system with the clinical disease pattern of thymoma was conducted. Pathologic slide specimens were carefully examined, details of postoperative treatment were documented, and a relationship with the prognostic outcome and recurrence was studied. Result: There were 7 patients in type A according to the WHO system of classification, 14 in AB, 28 in B 1, 23 in B2, 18 in B3, and 9 in type C. The study of the relationship between the Masaoka stage and WHO classification system showed 4 patients to be in WHO system type A, 7 in type AB, 22 in B 1, 17 in B2, and 3 in type B3 among 53 $(54{\%})$ patients shown to be in Masaoka stage I. Among 28 $(28.5{\%})$ patients in Masaoka stage II system, there were 2 patients in type A, 7 in AB, 4 in B 1, 2 in B2, 8 in B3, and 5 in type C. Among 15 $(15.3{\%})$ in Masaoka stage III, there were 1 patient in type B1, 3 in B2, 7 in B3, and 4 in type C. Finally, among 2 $(2{\%})$ patients found to be in Masaoka stage IV there was 1 patient in type B1, and 1 in type B2. The mean follow up duration was $28{\pm}6.8$ months. There were 3 deaths in the entire series of which 2 were in type B2 (Masaoka stages III and IV), and 1 was in type C (Masaoka stage II). Of the patients that experienced relapse, 6 patients remain alive of which 2 were in type B2 (Masaoka III), 2 in type B3 (Masaoka I and III) and 2 in type C (Masaoka stage II). The 5 year survival rate by the Kaplan-Meier method was $90{\%}$ for those in type B2 WHO classification system, $87.5{\%}$ for type C. The 5 year freedom from recurrence rate was $80.7{\%}$ for those in WHO type B2, $81.6{\%}$ for those in type B3, and $50{\%}$ for those in type C. By the Log-Rank method, a statistically significant correlation between survival and recurrence was found with the WHO system of classification (p<0.05). An analysis of the relationship between the WHO classification and Masaoka stage system using the Spearman correction method, showed a slope=0.401 (p=0.023), showing a close correlation. Conclusion: As type C of the WHO classification system is associated with a high postoperative mortality and recurrence rate, aggressive treatment postoperatively and meticulous follow up are warranted. The WHO classification and Masaoka stage system were found to have a close relationship with each other and either the WHO classification method or the Masaoka stage system may be used as a predict prognostic outcome of Thymoma.

Improvement in facies discrimination using multiple seismic attributes for permeability modelling of the Athabasca Oil Sands, Canada (캐나다 Athabasca 오일샌드의 투수도 모델링을 위한 다양한 탄성파 속성들을 이용한 상 구분 향상)

  • Kashihara, Koji;Tsuji, Takashi
    • Geophysics and Geophysical Exploration
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    • v.13 no.1
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    • pp.80-87
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    • 2010
  • This study was conducted to develop a reservoir modelling workflow to reproduce the heterogeneous distribution of effective permeability that impacts on the performance of SAGD (Steam Assisted Gravity Drainage), the in-situ bitumen recovery technique in the Athabasca Oil Sands. Lithologic facies distribution is the main cause of the heterogeneity in bitumen reservoirs in the study area. The target formation consists of sand with mudstone facies in a fluvial-to-estuary channel system, where the mudstone interrupts fluid flow and reduces effective permeability. In this study, the lithologic facies is classified into three classes having different characteristics of effective permeability, depending on the shapes of mudstones. The reservoir modelling workflow of this study consists of two main modules; facies modelling and permeability modelling. The facies modelling provides an identification of the three lithologic facies, using a stochastic approach, which mainly control the effective permeability. The permeability modelling populates mudstone volume fraction first, then transforms it into effective permeability. A series of flow simulations applied to mini-models of the lithologic facies obtains the transformation functions of the mudstone volume fraction into the effective permeability. Seismic data contribute to the facies modelling via providing prior probability of facies, which is incorporated in the facies models by geostatistical techniques. In particular, this study employs a probabilistic neural network utilising multiple seismic attributes in facies prediction that improves the prior probability of facies. The result of using the improved prior probability in facies modelling is compared to the conventional method using a single seismic attribute to demonstrate the improvement in the facies discrimination. Using P-wave velocity in combination with density in the multiple seismic attributes is the essence of the improved facies discrimination. This paper also discusses sand matrix porosity that makes P-wave velocity differ between the different facies in the study area, where the sand matrix porosity is uniquely evaluated using log-derived porosity, P-wave velocity and photographically-predicted mudstone volume.

Impact of Adjuvant Chemoradiation Therapy on the Postoperative 5-year Survival Rates for Stage-II Gastric Cancer (2기 위암환자의 수술 후 보조 항암요법 및 방사선 치료가 생존율에 미치는 영향)

  • Hong, Seong-Kweon;Choi, Min-Gew;Baik, Yong-Hae;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.281-287
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    • 2005
  • Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

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The Effects of Chest Injury in the Early Deaths of Trauma Patients (외상에 의한 초기 사망에서 흉부손상에 대한 고찰)

  • Lee Dong Hoon;Cho Dai Yun;Kim Chan Woong;Sohn Dong Suep
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.127-133
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    • 2006
  • Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

Effect of Freezing Temperature on Blueberry Quality (냉동 온도에 따른 블루베리의 품질 특성 비교)

  • Jo, Hye-Jin;Kim, Jung-Eun;Yu, Min-Ji;Lee, Wang-Hee;Song, Kyung Bin;Kim, Ha-Yun;Hwang, In Guk;Yoo, Seon Mi;Han, Gwi Jung;Park, Jong-Tae
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.12
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    • pp.1906-1912
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    • 2014
  • To evaluate the effect of freezing temperature on quality of blueberries, blueberry fruit was frozen at -20, -45, and $-70^{\circ}C$ immediately after harvest. After 24 hr of freezing, frozen blueberries were stored at $-20^{\circ}C$ for 2 months. Blueberries were thawed at $4^{\circ}C$ or $25^{\circ}C$ and subjected to subsequent analyses of drip ratio, fruit hardness, pH of juice, color, and sugar content. Frozen berries at all three temperatures did not show any significant difference in pH or sugar content compared with fresh berries. The drip ratio of berries decreased as the freezing temperature decreased. Thawing conditions significantly affected the drip ratio of berries frozen at $-20^{\circ}C$. Hardness of berries was significantly reduced after freeze-thawing. Freezing and thawing reduced total aerobic bacteria and yeast/mold numbers by more than 2 log regardless of freezing or thawing temperature ($4^{\circ}C$ or $25^{\circ}C$). Cross-section of blueberries did not show different shapes by freezing temperature. Further studies such as sensory evaluation are needed to determine the optimum freezing temperature regarding quality and cost.

Transmission Dose Estimation Algorithm for in vivo Dosimertry (투과선량을 이용한 생체내 (in vivo) 선량측정을 위한 알고리즘)

  • Yun, Hyong-Geun;Chie, Eui-Kyu;Huh, Soon-Nyung;Lee, Hyoung-Koo;Woo, Hong-Gyun;Shin, Kyo-Chul;Kim, Si-Yong;Ha, Sung-Whan
    • Journal of Radiation Protection and Research
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    • v.27 no.3
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    • pp.147-154
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    • 2002
  • Purpose : Measurement of transmission dose is useful for in vivo dosimetry of QA purpose. The objective of this study is to develope an algorithm for estimation of tumor dose using measured transmission dose for open radiation field. Materials and Methods : Transmission dose was measured with various field size (FS), phantom thickness (Tp), and phantom chamber distance (PCD) with a acrylic phantom for 6 MV and 10 MV X-ray. Source to chamber distance (SCD) was set to 150 cm. Measurement was conducted with a 0.6 co Farmer type ion chamber. Using measured data and regression analysis, an algorithm was developed lot estimation of expected reading of transmission dose. Accuracy of the algorithm was tested with flat solid phantom with various settings. Results : The algorithm consisted of quadratic function of log(A/P) (where A/P is area-perimeter ratio) and tertiary function of PCD. The algorithm could estimate dose with very high accuracy for open square field, with errors within ${\pm}0.5%$. For elongated radiation field, the errors were limited to ${\pm}1.0%$. Conclusion : The developed algorithm can accurately estimate the transmission dose in open radiation fields with various treatment settings.

Fluid Inclusion and Stable Isotope Geochemistry of the Yugeum Hydrothermal Gold Deposit in Youngduk, Korea (영덕 유금 열수 금광상에 대한 유체포유물과 안정동위원소 연구)

  • Kim, Sang-Woo;Lee, In-Sung;Shin, Dong-Bok
    • Journal of the Mineralogical Society of Korea
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    • v.23 no.1
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    • pp.1-13
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    • 2010
  • The Yugeum deposit in Youngduk in Gyungsangbuk-do is emplaced in the Cretaceous granitoids located in the Northeastem Gyeongsang Basin. Gold-bearing quartz veins filling the fracture with a direction of $N19^{\circ}{\sim}38^{\circ}W$ are most abundantly distributed within the Younghae granodiorite body. The formation of quartz veins can be classified into three main stages: barren quartz stage, auriferous quartz vein stage, and finally the extensive sulfide mineralization stage. Various sulfide minerals such as pyrite, chalcopyrite, galena, sphalerite, and arsenopyrite were precipitated during the hydrothermal gold mineralization process. Gold commonly occurs as fine-grained electrum in sulfides with high Au concentration (up to 93 wt%) compared to Ag. During the early gold mineralization stage, the temperature and pressure of the fluids are in the range of $220{\sim}250^{\circ}C$ and 730~1800 bar, and the oxygen fugacity is between $10^{-27}$ and $10^{-31.7}$ atm. On the other hand, the fluids of the late stage mineralization are characterized by temperature of $290{\sim}350^{\circ}C$ and pressure of 206~472 bar, and the oxygen fugacity is in the range of $10^{-26.3}{\sim}10^{-28.6}$ atm. The sulfur isotope compositions of sulfide minerals are in the range of $0.2{\sim}4.2^{\circ}/_{\circ\circ}$, while the ${\delta}^{34}SH_2S$ values range from 1.0 to $3.7^{\circ}/_{\circ\circ}$. The Ag/Au atomic ratios of electrum ranges from 0.15 to 1.10, and Au content is higher than Ag in most electrum. During the main gold mineralization stage at the relatively high temperature condition and with pH from 4.5 to 5.5, the stability of ${AuCl_2}^-$ increased while the stability of ${Au(HS)_2}^-$ decreased. Considering the pressure estimated in this deposit, the temperature of the ore fluid reached higher than $350^{\circ}C$ and ${AuCl_2}^-$ became an important species for the gold transportation. As mineralization proceeded with decreasing temperature and increasing pH and $f_{o2}$, the precipitation of sulfide minerals and accompanying electrum occurred.