• Journal of the Korean Society of Radiology
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• v.17 no.5
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• pp.743-749
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• 2023

Breast ductal carcinoma in situ(DCIS) refers to cases in which breast epithelial cells have become malignant but are still limited to normal ducts, and has been increasing rapidly in recent years. In this case, a two-year follow-up revealed findings on mammography and ultrasonography that indicated a small mass classified as BI-RADS Category 3, However far from typical malignant tumor these findings were. In the second year of follow-up, a hypoechoic mass with an indistinct boundary of the right breast in the 6 o'clock direction, on mammography appeared to be about 2.1×1.3 cm in size, and biopsy diagnosed it as ductal carcinoma. Since ductal endothelial cancer has no characteristic clinical findings and can show positive clinical and imaging findings in the early stages, regular follow-up is considered important for early diagnosis, and detection of ductal endothelial cancer through mammography and ultrasound is important for improving the prognosis of all breast cancer patients. During the initial examination conducted four years ago, we reported cases of intra ductal cancer in which asymmetric shading, microcalcification, and branched mass, indicative of intra ductal cancer, were observed during follow-up. It is advisable to concurrently explore methods for reducing X-ray dosage to mitigate potential side effects of contrast medium.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.1019-1027
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• 2022

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23-85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion: US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

• Korean Journal of Radiology
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• v.24 no.10
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Journal of the Korean Society of Radiology
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• v.84 no.3
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• pp.653-662
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• 2023

Purpose This study aimed to determine the incremental value of using a structured report (SR) for US examinations of the pediatric appendix. Materials and Methods Between January 2009 and June 2016, 1150 pediatric patients with suspected appendicitis who underwent US examinations of the appendix were included retrospectively. In November 2012, we developed a five-point scale SR for appendix US examinations. The patients were divided into two groups according to the form of the US report: free-text or SR. The primary clinical outcomes were compared between the two groups, including the rate of CT imaging following US examinations, the negative appendectomy rate (NAR), and the appendiceal perforation rate (PR). Results In total, 550 patients were included in the free-text group and 600 patients in the SR group. The rate of additional CT examinations decreased by 5.3% in the SR group (8.2%, p = 0.003), and the NAR decreased by 8.4% in the SR group (7.8%, p = 0.028). There was no statistical difference in the appendiceal PR (37.6% vs. 48.0%, p = 0.078). Conclusion The use of an SR to evaluate US examinations for suspected pediatric appendicitis results in lower CT use and fewer negative appendectomies without an increase in appendiceal PR.

• Science of Emotion and Sensibility
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• v.27 no.2
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• pp.81-90
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• 2024

In this study, we aimed to determine the effect on cerebral blood vessels of various stimulus intensities using transcutaneous electrical nerve stimulation (TENS). In particular, we wanted to monitor changes in blood flow and structural changes in the blood vessels in the common carotid artery (CCA) through low-intensity electrical stimulation that can cause non-perceptual sensory stimulation. Twenty-four healthy adults in their 20s participated in this study. Three stimulus intensities (below the sensory threshold, at the sensory threshold, and above the sensory threshold) were applied in random order. Changes in blood flow velocity according to the intensity of TENS stimulus were measured by placing the Doppler ultrasound transducer 1 cm below the CCA bifurcation, and the vascular structure was measured using B-mode imaging. C-mode Doppler and B-mode images were acquired before, during, and after the intervention for each stimulus, and changes in blood pressure were measured in each session. As a result, it was confirmed that peak systolic velocity (PSV) decreased significantly after the intervention in non-perceived sensory stimulation below the threshold, compared to other thresholds (p = .008). In particular, the PSV decreased by 3.04% on average compared to before stimulation (p = .011). However, there was no significant change in the CCA diameters before and after stimulation at all intensities. It was found that short-term, non-perceptual sensory stimulation was effective in reducing the blood flow rate without causing significant changes in either the blood vessel diameter or blood pressure. This change appears to be caused by a decrease in blood flow due to the effect of subtle vasodilation at non-perceptual sensory stimulation, and at stimulation intensity higher than that, the sympathetic nerves in the blood vessels are stimulated excessively and the blood vessels constrict. Therefore, this study can be rated as an important attempt to control blood flow through stimulation without such a psychological burden and sensory discomfort in the carotid area.

• Journal of the Korean Applied Science and Technology
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• v.36 no.3
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• pp.1028-1040
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• 2019

The current study was performed to investigate the magnitude of exercise-induced muscle damage (EIMD) after downhill running (DR) of different intensities and to examine the availability of muscle echo intensity as biomarkers to detect regional damage within quadriceps muscle group (QG) following DR. Healthy college-age men (n=11) were experienced twice DR sessions [$50%HR_{max}$ DR, LDR; $70%HR_{max}$ DR, HDR] separated by a 2-week wash-out period with the random order. After DR, severity of EIMD according to exercise intensity were determined by serum creatine kinase (CK) activity, muscle tenderness, and neuromuscular function indicators such as a maximal voluntary isometric contraction (MVIC) and range of motion (ROM). Transvaginal B-mode imaging had been employed to evaluate regional muscle echo intensity within QG [rectus femoris, RF; vastus lateralis, VL; vastus medialis, VM; vastus intermedius, VI]. After both DR sessions, changes in serum CK activity and muscle tenderness have tended to more increase in HDR compared to those of LDR. There was a significant interaction effect between exercise intensity during DR and the time course of serum CK activity(p<.05). However, there were no statistical differences between sessions in muscle tenderness. The time course of changes in the neuromuscular functions after DR were similar to those of regional muscle echo intensity regardless exercise intensity. Although neuromuscular function showed to decline in HDR more than those of LDR after DR, no statistical differences between sessions. In contrast, there were significant interaction effects between sessions and time course of changes in RF and VL muscle echo intensity(p<.01), but not shown in those of VI and VM. These results indicated that each muscles within the QG show different response profiles for EIMD during DR, exercise intensity influences on these responses as well. In particular, current findings suggested that muscle echo intensity derived from ultrasound imaging is capable of detecting regional muscle damage in QG following DR.

• Radiation Oncology Journal
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• v.26 no.2
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• pp.96-103
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• 2008

Purpose: To conduct a nationwide academic hospital patterns of the practice status and principles of radiotherapy for prostate cancer. The survey will help develop the framework of a database of Korean in Patterns of Case Study. Materials and Methods: A questionnaire about radiation treatment status and principles was sent to radiation oncologists in charge of prostate cancer treatment at thirteen academic hospitals in Korea. The data was analyzed to find treatment principles among the radiation oncologists when treating prostate cancer. Results: The number of patients with prostate cancer and treated with radiation ranged from 60 to 150 per academic hospital in Seoul City and 10 to 15 outside of Seoul City in 2006. The primary diagnostic methods of prostate cancer included the ultrasound guided biopsy on 6 to 12 prostate sites(mean=9), followed by magnetic resonance imaging and a whole body bone scan. Internal and external immobilizations were used in 61.5% and 76.9%, respectively, with diverse radiation targets. Whole pelvis radiation therapy(dose ranging from 45.0 to 50.4 Gy) was performed in 76.9%, followed by the irradiation of seminal vesicles($54.0{\sim}73.8$ Gy) in 92.3%. The definitive radiotherapy doses were increased as a function of risk group, but the range of radiation doses was wide(60.0 to 78.5 Gy). Intensity modulated radiation therapy using doses greater than 70 Gy, were performed in 53.8% of academic hospitals. In addition, the simultaneous intra-factional boost(SIB) technique was used in three hospitals; however, the target volume and radiation dose were diverse. Radiation therapy to biochemical recurrence after a radical prostatectomy was performed in 84.6%; however, the radiation dose was variable and the radiation field ranged from whole pelvis to prostate bed. Conclusion: The results of this study suggest that a nationwide Korean Patterns of Care Study is necessary for the recommendation of radiation therapy guidelines of prostate cancer.

• Advances in pediatric surgery
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• v.8 no.1
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• pp.16-22
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• 2002

Between March 1999 and January 2000, 82 boys with the diagnosis of inguinal hernias (12 bilateral and 70 unilateral hernias), underwent Ultrasound (US) examination of both sides of the groin, a total of 164 inguinal imaging prior to surgery. The patients ages ranged from 3 days to 12 years with a mean of 32.6 months. Ninty four examinations were on the clinically symptomatic side and 70 were on the asymptomatic side. The US criteria for the diagnosis of an inguinal hernia were as follows: 1) visceral hernia, the presence of bowel loops, or omentum in the inguinal canal, 2) communicating hydrocele, the presence of fluid in the processus vaginalis, 3) widening of patent processus vaginalis at the level of internal inguinal ring. The width of patent processus vaginalis at the level of internal inguinal ring over 4 mm is considered an occult hernia. Among the 94 symptomatic groins, US findings showed 31 (33%) visceral hernias, 18 (19%) communicating hydroceles, and 38 (41%) widening of the internal inguinal ring, and 7 (7%) groins without abnormalities. In 70 asymptomatic groins, there were 4 (6%) visceral hernias, 5 (7%) communicating hydroceles, 11 (16%) widening of the internal inguinal ring, and 50 (70%) groins without abnormalities. Among the 70 asymptomatic groins there were US abnormalities in 20 (28%). One hundred and seven groins with positive US findings were surgically explored. Among 107 operated sites, the operative findings were compatible with the US diagnosis in 104, a sensitivity for US of 97.2%. In patients with US findings of widening of internal inguinal ring (>4 mm), there was patent processus vaginalis in 36 out of 38 symptomatic groins and 10 of 11 asymptomatic groins. The sensitivity of US to the operative findings in widening of internal inguinal ring was 93.8%. For visceral hernia and communicating hydrocele, the sensitivity of positive US findings was 100%. Ultrasonography for inguinal hernias appears to be a rapid, reliable, and noninvasive screening diagnostic tool with high positive specificity. Therefore, we recommend the use of US as a routine diagnostic tool in pediatric patients with inguinal hernias and hydroceles.

• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.135-142
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• 2020

Purpose: This paper presents the long term follow-up results of arthroscopic partial repair for massive irreparable rotator cuff tears using a biceps long head auto graft. Materials and Methods: Forty-one patients with massive irreparable rotator cuff tear, who underwent arthroscopic repair, were reviewed retrospectively. Patients who underwent arthroscopic partial repair using a biceps long head auto graft were assigned to group 1, and patients in group 2 underwent arthroscopic partial repair alone. Patients with a less than 50% partial tear of the long head biceps tendon were included in this study. The clinical scores were measured using a visual analogue pain scale (VAS) for pain, range of motion (ROM), The University of California, Los Angeles shoulder score (UCLA), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Korean Shoulder Scoring System (KSS) scores preoperatively and at the final follow-up. The acromiohumeral interval (AHI) was measured using plain radiographs taken preoperatively and at the final follow-up, and re-tear was evaluated using postoperative ultrasound or magnetic resonance imaging at the last follow-up. Results: The mean age of the patients was 62.1±12.7 years, and the mean follow-up period was 90.3±16.8 months. No significant differences in the VAS and ROM (forward flexion, external rotation, internal rotation) were found between the two groups (p=0.179, p=0.129, p=0.098, p=0.155, respectively). The UCLA (p=0.041), ASES (p=0.023), and KSS (p=0.019) scores showed functional improvements in group 1 compared to group 2. At the last follow-up, the measured AHI values were 9.46±0.41 mm and 6.86±0.64 mm in group 1 and 2, respectively (p=0.032). Re-tear was observed in six out of 21 cases (28.6%) in group 1 and nine out of 20 cases (45.0%) in group 2; the retear rate was significantly lower in group 1 than in group 2 (p=0.011). Conclusion: Arthroscopic partial repair for a massive irreparable rotator cuff tear using a biceps long head auto graft has significant clinical usefulness in functional recovery and decreases the re-tear rates after surgery than arthroscopic partial repair alone, showing favorable results after a long-term follow-up.