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The Effect of Hounsfield Unit Value with Conventional Computed Tomography and Intraoperative Distraction on Postoperative Intervertebral Height Reduction in Patients Following Stand-Alone Anterior Cervical Discectomy and Fusion

  • Lee, Jun Seok;Son, Dong Wuk;Lee, Su Hun;Ki, Sung Soon;Lee, Sang Weon;Song, Geun Sung;Woo, Joon Bum;Kim, Young Ha
    • Journal of Korean Neurosurgical Society
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    • v.65 no.1
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    • pp.96-106
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    • 2022
  • Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

The Effect of Pilates Exercise for Lumbar Stabilization focused on Body Shape Improvement and Pain Relief of Senior Women with Chronic Back Pain (요부안정화 중심의 필라테스 운동이 만성요통을 가진 여성노인의 체형 및 통증에 미치는 영향)

  • Boon-Hong Yeon;Eul-Seob An
    • Journal of the Korean Applied Science and Technology
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    • v.40 no.1
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    • pp.95-102
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    • 2023
  • The purpose of this study is to figure out the effect of 12 weeks pilates program for body shape improvement and lumbar stabilization of senior women with chronic back pain and to provide data for developing excercise program which is appropriate for senior women to make aging delayed and to have more physical activity domain by inquiring into their pain reducing. The subjects of this study were 16 senior women with chronic back pain which were classified into two group with experimental group(n=8) and control group(n=8) by applying simple random sampling after conducting Visual Analogue Scale(VAS). Their motion range of pain was from 3 centimeters to 5 centimeters. Pilates excercise for lumbar stabilization in this study was originated the previous literature of Lee et al(2011) and the excercise was modified in the form of pilates. The program in the study was performed under the guidance of a professional pilates trainer. The results are as follows. Firstly, the experimental group showed positive improvement in making vertebra slope but the control group showed pain increased. Secondly, the lumbar pain decreased in the experimental group but it increased in the control group. As a result, the pilates program for lumbar stabilization can be considered as a program for pain relief and body shape improvement of senior women with chronic back pain.

Development and Validation of a Deep Learning System for Segmentation of Abdominal Muscle and Fat on Computed Tomography

  • Hyo Jung Park;Yongbin Shin;Jisuk Park;Hyosang Kim;In Seob Lee;Dong-Woo Seo;Jimi Huh;Tae Young Lee;TaeYong Park;Jeongjin Lee;Kyung Won Kim
    • Korean Journal of Radiology
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    • v.21 no.1
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    • pp.88-100
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    • 2020
  • Objective: We aimed to develop and validate a deep learning system for fully automated segmentation of abdominal muscle and fat areas on computed tomography (CT) images. Materials and Methods: A fully convolutional network-based segmentation system was developed using a training dataset of 883 CT scans from 467 subjects. Axial CT images obtained at the inferior endplate level of the 3rd lumbar vertebra were used for the analysis. Manually drawn segmentation maps of the skeletal muscle, visceral fat, and subcutaneous fat were created to serve as ground truth data. The performance of the fully convolutional network-based segmentation system was evaluated using the Dice similarity coefficient and cross-sectional area error, for both a separate internal validation dataset (426 CT scans from 308 subjects) and an external validation dataset (171 CT scans from 171 subjects from two outside hospitals). Results: The mean Dice similarity coefficients for muscle, subcutaneous fat, and visceral fat were high for both the internal (0.96, 0.97, and 0.97, respectively) and external (0.97, 0.97, and 0.97, respectively) validation datasets, while the mean cross-sectional area errors for muscle, subcutaneous fat, and visceral fat were low for both internal (2.1%, 3.8%, and 1.8%, respectively) and external (2.7%, 4.6%, and 2.3%, respectively) validation datasets. Conclusion: The fully convolutional network-based segmentation system exhibited high performance and accuracy in the automatic segmentation of abdominal muscle and fat on CT images.

Prognostic Value of Sarcopenia and Myosteatosis in Patients with Resectable Pancreatic Ductal Adenocarcinoma

  • Dong Wook Kim;Hyemin Ahn;Kyung Won Kim;Seung Soo Lee;Hwa Jung Kim;Yousun Ko;Taeyong Park;Jeongjin Lee
    • Korean Journal of Radiology
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    • v.23 no.11
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    • pp.1055-1066
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    • 2022
  • Objective: The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods: We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 [0.94-2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not. Conclusion: Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.

Simultaneous Estimation of the Fat Fraction and R2* Via T2*-Corrected 6-Echo Dixon Volumetric Interpolated Breath-hold Examination Imaging for Osteopenia and Osteoporosis Detection: Correlations with Sex, Age, and Menopause

  • Donghyun Kim;Sung Kwan Kim;Sun Joo Lee;Hye Jung Choo;Jung Won Park;Kun Yung Kim
    • Korean Journal of Radiology
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    • v.20 no.6
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    • pp.916-930
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    • 2019
  • Objective: To investigate the relationships of T2*-corrected 6-echo Dixon volumetric interpolated breath-hold examination (VIBE) imaging-based fat fraction (FF) and R2* values with bone mineral density (BMD); determine their associations with sex, age, and menopause; and evaluate the diagnostic performance of the FF and R2* for predicting osteopenia and osteoporosis. Materials and Methods: This study included 153 subjects who had undergone magnetic resonance (MR) imaging, including MR spectroscopy (MRS) and T2*-corrected 6-echo Dixon VIBE imaging. The FF and R2* were measured at the L4 vertebra. The male and female groups were divided into two subgroups according to age or menopause. Lin's concordance and Pearson's correlation coefficients, Bland-Altman 95% limits of agreement, and the area under the curve (AUC) were calculated. Results: The correlation between the spectroscopic and 6-echo Dixon VIBE imaging-based FF values was statistically significant for both readers (pc = 0.940 [reader 1], 0.908 [reader 2]; both p < 0.001). A small measurement bias was observed for the MRS-based FF for both readers (mean difference = -0.3% [reader 1], 0.1% [reader 2]). We found a moderate negative correlation between BMD and the FF (r = -0.411 [reader 1], -0.436 [reader 2]; both p <0.001) with younger men and premenopausal women showing higher correlations. R2* and BMD were more significantly correlated in women than in men, and the highest correlation was observed in postmenopausal women (r = 0.626 [reader 1], 0.644 [reader 2]; both p < 0.001). For predicting osteopenia and osteoporosis, the FF had a higher AUC in men and R2* had a higher AUC in women. The AUC for predicting osteoporosis was highest with a combination of the FF and R2* in postmenopausal women (AUC = 0.872 [reader 1], 0.867 [reader 2]; both p < 0.001). Conclusion: The FF and R2* measured using T2*-corrected 6-echo Dixon VIBE imaging can serve as predictors of osteopenia and osteoporosis. R2* might be useful for predicting osteoporosis, especially in postmenopausal women.

Development of Eggs, Larvae and Juveniles of the Boleophthalmus pectinirostris from Southern Coastal, Yeoja-man (남해안 여자만에 서식하는 짱뚱어 Boleophthalmus pectinirostris의 난발생 및 자치어 형태발달)

  • Chung-Kug Park;Seon-Yeong Hwang;Dae-Hong Kim;Seung-Jun Heo;Jae-Min Park
    • Korean Journal of Ichthyology
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    • v.36 no.1
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    • pp.1-9
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    • 2024
  • This study investigated the early life history of the Boleophthalmus pectinirostris living in the southern coastal Yeoja-man and compared the results with the same Gobiidae fishes. The brood stork used in the study were captured with bare hands in the tidal flats of Beolgyo-eup, Jeollanam-do, in June 2015. The amount of spawning was 411~11,688, and the eggs were short oval and the size was 1.40×0.72 mm. The time of hatched took 91 hours and 35 minutes at a water temperature of 25~27℃. Newly hatching larvae, the yolk sac had a total length of 3.02~3.31 (average 3.17±0.08, n=30) mm and did not eat rotifer. 4 days after hatching, the total length was 3.31~3.52 (3.43±0.07, n=30) mm, and as the mouth and anus opened, the fish transitioned to the preflexion larvae and fed. 14 days after hatching, the total length was 5.06~5.25 (5.16±0.06, n=30) mm, and the distal end of the vertebra was completely bent at 45° and the transitioned to the postflexion larvae. 41 days after hatching, the total length was 14.3~16.8 (15.4±0.85 mm, n=30), and the number of fins reached an integer of 5 first dorsal fins, 26~27 second dorsal fins, 24~27 anal fins, and 6 ventral fins, and the transitioned to the juveniles. As a result of the study, star-shaped melanophore were deposited from the front of the pectoral fin to the base of the caudal fin, which distinguished them in form from other postflexion larvae of Gobiidae fishes.

Correlation analysis of primal cuts weight, fat contents, and auction prices in Landrace × Yorkshire × Duroc pig carcasses by VCS2000

  • Youngho Lim;Yunhwan Park;Gwantae Kim;Jaeyoung Kim;Jongtae Seo;Jaesik Lee;Jungseok Choi
    • Journal of Animal Science and Technology
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    • v.66 no.4
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    • pp.834-845
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    • 2024
  • Currently, in pork auctions in Korea, only carcass weight and backfat thickness provide information on meat quantity, while the production volume of primal cuts and fat contents remains largely unknown. This study aims to predict the production of primal cuts in pigs and investigate how these carcass traits affect pricing. Using the VCS2000, the production of shoulder blade, loin, belly, shoulder picnic, and ham was measured for gilts (17,257 pigs) and barrows (16,365 pigs) of LYD (Landrace × Yorkshire × Duroc) pigs. Single and multiple regression analysis were conducted to analyze the relationship between the primal cuts and carcass weight. The study also examined the correlation between each primal cut, backfat thickness (1st thoracic vertebra backfat thickness, grading backfat thickness, and Multi-brached muscle middle backfat thickness), pork belly fat percentage, total fat yield, and auction price. A multiple regression analysis was conducted between the carcass traits that showed a high correlation and the auction price. After conducting a single regression analysis on the primal cuts of gilt and barrow, all coefficients of determination (R2) were 0.77 or higher. In the multiple regression analysis, the R2 value was 0.98 or higher. The correlation coefficient between the carcass weights and the auction price exceeded 0.70, while the correlation coefficients between the primal cuts and the auction prices were above 0.65. In terms of fat content, the backfat thickness of gilt exhibited a correlation coefficient of 0.70, and all other items had a correlation coefficient of 0.47 or higher. The correlation coefficients between the Forequarter, Middle, and Hindquarter and the auction price were 0.62 or higher. The R2 values of the multiple regression analysis between carcass traits and auction price were 0.5 or higher for gilts and 0.4 or higher for barrows. The regression equations between carcass weight and primal cuts derived in this study exhibited high determination coefficients, suggesting that they could serve as reliable means to predict primal cut production from pig carcasses. Elucidating the correlation between primal cuts, fat contents and auction prices can provide economic indicators for pork and assist in guiding the direction of pig farming.

Changes in atlas position with Class ll activator treatment in Class II malocclusion patients (II급 부정교합자에서 액티베이터 사용에 따른 atlas의 위치 변화에 관한 연구)

  • Cho, Moon-Ki;Cha, Kyung-Suk;Chung, Dong-Hwa;Lee, Jin-Woo
    • The korean journal of orthodontics
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    • v.37 no.1 s.120
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    • pp.44-55
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    • 2007
  • Objective: Previous studies have reported that morphological features of the first cervical vertebra (atlas) have been associated with mandibular growth direction. The purpose of this study was to show the possible positional and morphological changes of the Atlas from activator treatment in Class II malocclusion patients. Methods: Lateral cephalometric radiograph tracings were made at initial, middle and final stages of treatment. Angular and linear measurements of skeletal and morphological features were measured on the anatomical landmarks and reference planes. Results: The skeletal effects of activator treatment on Class II malocclusion patients were evident on ramal height, body length, effective body length, ANB, and overjet. Clockwise rotation of the long axis of the Atlas was found in Group 1, but there was no inclination change of the Atlas in groups 2 and 3. There was no significant correlation between anterior and posterior positions of the atlas or morphological change in all groups. - except for posterior movements of the Atlas found in group 1. Conclusion: Clockwise rotation of the atlas axis resulted from activator treatment in Cl II malocclusion patients. Change in atlas axis can be thought of as an indicator for success of activator treatment.

Clinical Significance of MRI Findings During Medical Treatment for Tuberculous Spondylitis (척추염 환자의 약물치료기간 중 추적 검사한 MRI소견 변화의 임상적 중요성)

  • Kim, Dae-Jung;Chung, Tae-Sub;Suh, Sang-Hyun;Kim, Keun-Su;Cho, Yong-Eun;Yoon, Young-Sul;Kim, Sam-Soo
    • Investigative Magnetic Resonance Imaging
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    • v.13 no.2
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    • pp.146-151
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    • 2009
  • Purpose : To evaluate magnetic resonance (MR) imaging features of non-surgically treated tuberculous spondylitis and to evaluate the relationships between these features and clinical outcomes. Materials and Methods : Data from ten patients (male:female=6:4, mean age=45 years) with clinically proven tuberculous spondylitis who were treated nonsurgically over three months were analyzed retrospectively from 2000 to 2007. MRI was performed at least three times for each patient, at baseline, every three or six months, and at the end of treatment. All images were analyzed by two radiologists. Results : The mean follow-up period for the MR examination was 10.1 months (range, 4-17 months). Six patients had clinically complete resolution of tuberculous spondylitis with medication treatment only. Four patients were treated with surgical management alongside medication. All ten patients were divided into two groups by clinical outcome; six patients with complete treatment and four patients with incomplete treatment. In the complete treatment group, follow-up MR findings showed a loss of subligamentous spread of abscesses, decreased size of abscesses, no interval changes in vertebral body heights, and fatty changes in spinal lesions. MR findings in the incomplete treatment group showed bone marrow edema extension to adjacent vertebra, extension of the abscesses, and decreased height of the vertebral bodies. Conclusion : During the nonsurgical management of tuberculous spondylitis, MR imaging may play a role in predicting patient response to antituberculous drug treatment.

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Bone Mineral Density and Bone Markers in the Children with Epilepsy Taking on Chronic Anticonvulsants (장기간 항경련제를 복용하고 있는 소아 간질 환아들의 골밀도 및 골대사 지표들)

  • Lee, Soon Bum;Kang, So Young;Yu, Jeesuk
    • Clinical and Experimental Pediatrics
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    • v.48 no.5
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    • pp.527-533
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    • 2005
  • Purpose : Long-term administration of anticonvulsants in children with epilepsy may cause short stature, hypocalcemia and low bone mineral density. This study was performed for the early detection of abnormal bone metabolism in children with epilepsy on taking anticonvulsants. Methods : Thirty children aged 5 to 16 years who were diagnosed with epilepsy were enrolled in this study. All had taken anticonvulsants for more than one year. Bone mineral density of lumbar vertebra was measured by dual-energy X-ray absorptiometry. Serum calcium, phosphorous, alkaline phosphatase, 25-hydroxycholecalciferol[$25(OH)D_3$], parathyroid hormone, and urine deoxypyridinoline were measured as biochemical bone markers. Bone age and body mass index were also calculated. Results : Bone minreal density, body mass index, bone age, and height were significantly decreased in two female patients who had taken two antiepileptic drugs for more than four years and they also had chronic diseases such as cerebral palsy with microcephaly, encephalomalacia, and microcephaly with atrial septal defect. Bone mineral density had significant positive correlations with body mass index(P<0.01) and bone age(P<0.01). Conclusion : This study showed chronic medication of anticonvulsants in children may cause low bone mineral density and short stature. Bone age and body mass index could be the important surrogate markers to find the population at risk. More studies, including a large study population and long term cohort study, will be required.