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Unenhanced Breast MRI With Diffusion-Weighted Imaging for Breast Cancer Detection: Effects of Training on Performance and Agreement of Subspecialty Radiologists

  • Yeon Soo Kim;Su Hyun Lee;Soo-Yeon Kim;Eun Sil Kim;Ah Reum Park;Jung Min Chang;Vivian Youngjean Park;Jung Hyun Yoon;Bong Joo Kang;Bo La Yun;Tae Hee Kim;Eun Sook Ko;A Jung Chu;Jin You Kim;Inyoung Youn;Eun Young Chae;Woo Jung Choi;Hee Jeong Kim;Soo Hee Kang;Su Min Ha;Woo Kyung Moon
    • Korean Journal of Radiology
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    • v.25 no.1
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    • pp.11-23
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    • 2024
  • Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). Conclusion: Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Single Center Experience of the Balloon-Stent Technique for the Treatment of Unruptured Distal Internal Carotid Artery Aneurysms: Sharing a Simple and Reliable Tip to Use Scepter-Atlas Combination (원위내경동맥에 위치한 비파열성 동맥류의 치료에 있어 풍선-스텐트 테크닉에 대한 단일기관의 경험: Scepter-Atlas 조합을 사용하기 위한 간단하지만 확실한 방법)

  • Yu-jung Park;Jieun Roh;Seung Kug Baik;Jeong A Yeom;Chul-Hoo Kang;Hee Seok Jeong;Sang Won Lee
    • Journal of the Korean Society of Radiology
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    • v.82 no.5
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    • pp.1258-1273
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    • 2021
  • Purpose The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

Prevalence of Incidentally Detected Spondylolysis in Children (소아 환자에서 우연히 발견되는 척추분리증의 유병률)

  • Boram Song;Sun Kyoung You;Jeong Eun Lee;So Mi Lee;Hyun-Hae Cho
    • Journal of the Korean Society of Radiology
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    • v.83 no.1
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    • pp.127-137
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    • 2022
  • Purpose To assess the prevalence of incidentally detected lumbar spondylolysis in children. Materials and Methods We retrospectively reviewed the data of 809 patients under the age of 11 years (mean age, 7.0 ± 2.7 years; boys:girls = 479:330) who underwent abdominal and pelvic CT between March 2014 and December 2018. We recorded the presence, level, and laterality (unilateral or bilateral) of spondylolysis. Patients were divided into two groups based on the presence of spondylolysis: the spondylolysis (SP) and non-SP groups. Results In total, 21 cases of spondylolysis were detected in 20 patients (20/809, 2.5%). The mean age of the SP group was higher than that of the non-SP group (7.8 ± 1.8 vs. 6.9 ± 2.7 years, p > 0.05). The prevalence of spondylolysis in boys was higher than that in girls (15/479 [3.1%] vs. 5/330 [1.5%], p > 0.05). The prevalence of spondylolysis in school-age children (6-10 year olds) was higher than that in preschool-age children (0-5 year olds) (17/538 [3.2%] vs. 3/271 [1.1%], p > 0.05). L5 was the most common level of spondylolysis (76.2%); one 8-year-old boy had two-level spondylolysis. One case of isthmic spondylolisthesis was detected in a 10-year-old boy (1/809, 0.1%). There were 11 unilateral spondylolysis cases (11/21, 52.4%). Conclusion In our study, the prevalence of spondylolysis in children under the age of 11 was 2.5%. The prevalence was higher in boys than in girls and in school-age than in preschool-age children, despite the lack of any statistically significant differences.

Radiomics Analysis of Gray-Scale Ultrasonographic Images of Papillary Thyroid Carcinoma > 1 cm: Potential Biomarker for the Prediction of Lymph Node Metastasis (Radiomics를 이용한 1 cm 이상의 갑상선 유두암의 초음파 영상 분석: 림프절 전이 예측을 위한 잠재적인 바이오마커)

  • Hyun Jung Chung;Kyunghwa Han;Eunjung Lee;Jung Hyun Yoon;Vivian Youngjean Park;Minah Lee;Eun Cho;Jin Young Kwak
    • Journal of the Korean Society of Radiology
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    • v.84 no.1
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    • pp.185-196
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    • 2023
  • Purpose This study aimed to investigate radiomics analysis of ultrasonographic images to develop a potential biomarker for predicting lymph node metastasis in papillary thyroid carcinoma (PTC) patients. Materials and Methods This study included 431 PTC patients from August 2013 to May 2014 and classified them into the training and validation sets. A total of 730 radiomics features, including texture matrices of gray-level co-occurrence matrix and gray-level run-length matrix and single-level discrete two-dimensional wavelet transform and other functions, were obtained. The least absolute shrinkage and selection operator method was used for selecting the most predictive features in the training data set. Results Lymph node metastasis was associated with the radiomics score (p < 0.001). It was also associated with other clinical variables such as young age (p = 0.007) and large tumor size (p = 0.007). The area under the receiver operating characteristic curve was 0.687 (95% confidence interval: 0.616-0.759) for the training set and 0.650 (95% confidence interval: 0.575-0.726) for the validation set. Conclusion This study showed the potential of ultrasonography-based radiomics to predict cervical lymph node metastasis in patients with PTC; thus, ultrasonography-based radiomics can act as a biomarker for PTC.

Benign Adenomyoepithelioma of the Breast: Imaging Characteristics (유방의 양성 선근상피세포종: 영상 특징)

  • So Ra Shin;Eun Young Ko;Boo-Kyung Han;Eun Sook Ko;Ji Soo Choi;Haejung Kim
    • Journal of the Korean Society of Radiology
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    • v.84 no.2
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    • pp.398-408
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    • 2023
  • Purpose This study aimed to evaluate the radiological and clinical characteristics of benign adenomyoepitheliomas of the breast. Materials and Methods Over the last 20 years, 120 patients were histologically diagnosed with breast adenomyoepithelioma (AME) at our institution. We excluded 43 patients who were incidentally diagnosed during mastectomy for breast cancer, 28 who underwent percutaneous biopsy without further excision, and 8 who had biopsy-confirmed benign AME and were found to have another pathology after complete excision. We retrospectively reviewed the clinical records and radiological findings of the remaining 41 patients with histologically diagnosed benign breast AMEs after complete excision. Results All 41 patients underwent US; 38 underwent mammography (MG) and US; and 18 underwent MG, US, and MRI. MG detected 38 cases with a round or oval shape (56%), and mass (89%), were non-circumscribed (62%), hyperdense (53%), and without microcalcifications (95%). Breast US revealed suspicious masses (98%) with a non-circumscribed margin (66%), hypoechogenicity (43%), and intratumoral vascularity (63%). All lesions on breast MRI showed suspicious masses (100%) with ill-defined margins (61%), and 84% showed wash-out kinetics. Benign AMEs showed suspicious features of Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 in 83%-95% of the MG, US, and MRI. Sixteen of the 41 cases were misdiagnosed on the initial core needle biopsy and two were diagnosed as malignancy. Conclusion Benign breast AME often shows suspicious radiological features mimicking a malignant mass on MG, US, and MRI. Differentiating benign AME from other pathologies might be difficult on core needle biopsy, and complete excision is needed for a correct diagnosis.

Analysis of Amino Acids, Fatty Acids, and Antioxidant Activities of Prunus yedoensis Matsum. Bark Extracts (왕벚나무 수피 추출물의 아미노산, 지방산 분석 및 항산화 활성)

  • Sung-Hwan Park;Ye-Eun Choi;Jung-Mo Yang;Chae-Won Jeong;Hyun-Duck Jo;Ju-Hyun Cho
    • Journal of Food Hygiene and Safety
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    • v.39 no.3
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    • pp.288-298
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    • 2024
  • This study aimed to investigate the amino acid content, fatty acid composition, total flavonoid and phenol contents, and antioxidant activities of Prunus yedoensis Matsum. bark extracts using various extraction solvents. Through amino acid analysis, 13 amino acids were detected in extracts obtained using hot water, 30% ethanol, and 70% ethanol. The major amino acids were identified as aspartic acid, arginine, and proline, and the total amino acid content was 0.17%, 0.16%, and 0.09%, respectively. Fatty acid analysis showed a saturated fatty acid (SFA) ratio of 62.7-66.7% in extracts obtained using hot water, 30% ethanol, and 70% ethanol, with the primary fatty acid identified as palmitic acid. The total flavonoid and polyphenol contents were 727.70-769.87 mg quercetin equivalent (QE)/ g and 309.24-348.09 mg gallic acid equivalent (GAE)/g, respectively, in extracts obtained using hot water, 30% ethanol, and 70% ethanol extracts. Measurements of antioxidant activity confirmed that extracts obtained using hot water, 30% ethanol, and 70% ethanol extracts increased the antioxidant effect in 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activity, and ferric reducing antioxidant power (FRAP) in a concentration-dependent manner. A high correlation was observed between the total flavonoid content, total polyphenol content, and antioxidant activities of the extracts. This study provides data and novel insights for the development of functional food materials using P. yedoensis Matsum. bark extracts.

Deep Learning-based Fracture Mode Determination in Composite Laminates (복합 적층판의 딥러닝 기반 파괴 모드 결정)

  • Muhammad Muzammil Azad;Atta Ur Rehman Shah;M.N. Prabhakar;Heung Soo Kim
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.37 no.4
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    • pp.225-232
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    • 2024
  • This study focuses on the determination of the fracture mode in composite laminates using deep learning. With the increase in the use of laminated composites in numerous engineering applications, the insurance of their integrity and performance is of paramount importance. However, owing to the complex nature of these materials, the identification of fracture modes is often a tedious and time-consuming task that requires critical domain knowledge. Therefore, to alleviate these issues, this study aims to utilize modern artificial intelligence technology to automate the fractographic analysis of laminated composites. To accomplish this goal, scanning electron microscopy (SEM) images of fractured tensile test specimens are obtained from laminated composites to showcase various fracture modes. These SEM images are then categorized based on numerous fracture modes, including fiber breakage, fiber pull-out, mix-mode fracture, matrix brittle fracture, and matrix ductile fracture. Next, the collective data for all classes are divided into train, test, and validation datasets. Two state-of-the-art, deep learning-based pre-trained models, namely, DenseNet and GoogleNet, are trained to learn the discriminative features for each fracture mode. The DenseNet models shows training and testing accuracies of 94.01% and 75.49%, respectively, whereas those of the GoogleNet model are 84.55% and 54.48%, respectively. The trained deep learning models are then validated on unseen validation datasets. This validation demonstrates that the DenseNet model, owing to its deeper architecture, can extract high-quality features, resulting in 84.44% validation accuracy. This value is 36.84% higher than that of the GoogleNet model. Hence, these results affirm that the DenseNet model is effective in performing fractographic analyses of laminated composites by predicting fracture modes with high precision.

Accuracy of bite registration according to the buccal bite scan range of intra-oral scanner (구강 스캐너의 협측 교합 스캔 부위에 따른 교합 인기의 정확도)

  • Tae-sung Kwon;Dae-hyun Kim;Min-su Kim;Dong-jun Song;Joo-Hun Song
    • Journal of Dental Rehabilitation and Applied Science
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    • v.40 no.3
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    • pp.125-134
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    • 2024
  • Purpose: The aim of this study was to determine which scan range would provide the most accurate bite registration when performing a bite scan after scanning an upper and lower arch using an intraoral scanner. Materials and Methods: The occlusal contact points were recorded using articulating paper for 30 adults, and the results of various ranges of buccal bite scan were compared based on this. Buccal bite scan of 5 ranges (1st premolar to 2nd premolar, 1st premolar to 1st molar, 1st premolar to 2nd molar, 2nd premolar to 1st molar, and canines to another side canine of the maxillary teeth) was performed, and then the buccal bite scan file was used in a CAD program to confirm the occlusal area in the scan file through data editing and alignment, leaving the buccal area of the teeth. Afterwards, the degree of agreement between the occlusal contact points obtained from the articulating paper and the occlusal area obtained from the scan file was compared, and statistical analysis was performed using the homoscedastic T-test (α = 0.05). Results: The alignment success and alignment failure rates among each group were 77.23% and 40.85% in canine to another side canine, 68.23% and 28.89% in bilateral first premolar to second premolar, 63.76% and 29.97% in bilateral first premolar to first molar, 61.31% and 32.04% in bilateral first premolar to second molar, 67.55% and 27.46% in second premolar to first molar. The results of the anterior scan of both canines showed higher alignment success and failure rates compared to the scan results of all maxillary posterior teeth. In the alignment success rate, statistical significance was not found depending on the scan range of the posterior teeth, but in comparing the results of the posterior teeth and both canines, statistical significance was observed except for the scan results of the second premolar to the first molar. There was no statistical significance in the alignment failure rate depending on the scan range of the posterior teeth, and statistical significance was observed in the results of the posterior teeth and both canines. Conclusion: When taking a buccal bite scan, in the case of scanning the anterior teeth, more occlusal area appear than when scanning the posterior teeth, and in the case of scanning the posterior teeth, there is no significant difference in the bite registration depending on the scan range.

Studies on the effect of phthalimido methyl-O,O-dimethyl-phosphorodithioate (Imidan) and its possible metabolites on the growth of rice plant (Phthalimido methyl-O,O-dimethyl phosphorodithioate (Imidan)과 그의 대사물질(代謝物質)이 수도(水稻) 생육(生育)에 미치는 영향(影響)에 관(關)한 연구(硏究))

  • Lee, Sung-Hwan;Lee, Dong-Suk;Lee, Jae-Koo
    • Applied Biological Chemistry
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    • v.7
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    • pp.105-117
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    • 1966
  • This experiment was conducted to investigate the effet of phthalimido-methyl-O,O-dimethyl-phosphorodithioate (Imidan) known as an acaricide and its possible metabolic products on the growth of plant, when sprayed on the leaves of rice plant. The results are summarized as follows. 1) Possible metabolic products of Imidan, the following compounds were synthesized or recrystallized for the present experiment a) N-Hydroxymethyl phthalimidem b) Phthalimide c) Phthalamidic acid d) Phthalic acid e) Anthranilic acid f) p-Amino benzoic acid g) p-Hydroxy benzoic acid h) Benzoic acid 2) Among the above materials, a), c), d), e), and Imidan were dissolved in a buffer solution respectively to be 10 and 20 p.p.m. and tested with the wheat coleoptile straight growth method. According to the results, Imidan inhibited the growth of coleoptile in both 10 and 20 p.p.m., whereas the others showed much better growth than the control, especially phthalamidic acid in 10 p.p.m. It appears that Imidan itself inhibits the coleoptile growth, whereas the metabolites derived from Imidan through various metabolisms, including hydrolysis in plant tissues show growth-regulating activity. (refer: Table 1, Fig. 1) 3) 20, 100 and 200 p.p.m. solutions of Imidall emulsion in xylene f·ere prepared. The lengths of shoot and root of rice seeds germinated on the re-respective media were measured after 12 days. The data showed that root was much more elongated in Imidan 20 p.p.m., whereas shoot in Imidan 100 p.p.m., respectively, than in the xylene control. An interesting finding was that xylene used as solvent had a tendency to inhibit seriously the root growth of rice seed. (refer: Table 2,5). 4) The emulsions of concentrations in 10, 25, 50 and 100 p.p.m's of control, Imidan, N-hydroxy methyl phthalimide, anthranilic acid, and phthalmide, respectively, were sprayed twice on the rice plant on pot. After a certain period of time lengths of rice culms were measured, showing that plots treated with Imidan and N-hydroxy methyl phthalimide exhibited much more growth than those of control and the others. 5) Loaves and stems of rice plant were sampled and extracted with dried acetone at the intervals of 3-, 5-, 7-, and 14 days after treated with Imidan 250 p.p.m. emulsion. This sample extracted with acetone was purified by means of prechromatographic purification method with acetonitrile and paperchromatographed to detect the following metabolic products. Imidan (Rf: 0.97-0,98), N-hydroxy-methyl phthalimide (Rf: 0.87) phthalimide (Rf: 0.86-0.87), phthalamidic acid (Rf: 0.13-0.14), phthalic acid (Rf: 0.02-0.03), benzoic acid (Rf: 0.42-0.43), p-amino benzoic acid or p-hydroxy benzoic acid (Rf: 0.08-0.09), and unidentified compounds (Rf: 0.73, 0.59, 0.33, 0.23. 0.07). In addition, in the early stages, such as 3- and 5 days nonhydrolyzed Imidan and its first hydrolytic product, N-hydroxymethyl phthalimide were detected in relatively large amounts, whereas in the last stages of 7- and 14 days due to further decomposition, the afore-mentioned two materials were reduced in the amount and p-hthalic, phthalamidic, benzoic, and p-Hydroxy benzoic, or p-Amino benzoic acids were detected in a considerably large amount. It is, therefore, believed that most of Imidan applied to the leaves of rice plant may be decomposed within almost 14 days. In the light of above observations it is considered that Imidan itself is not involved in plant growth regulating activity, whereas various phthaloyl derivatives produced in the course of metabolism (namelr, enzymic action) in plant tissues may have such effect.

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Assessment of Bone Metastasis using Nuclear Medicine Imaging in Breast Cancer : Comparison between PET/CT and Bone Scan (유방암 환자에서 골전이에 대한 핵의학적 평가)

  • Cho, Dae-Hyoun;Ahn, Byeong-Cheol;Kang, Sung-Min;Seo, Ji-Hyoung;Bae, Jin-Ho;Lee, Sang-Woo;Jeong, Jin-Hyang;Yoo, Jeong-Soo;Park, Ho-Young;Lee, Jae-Tae
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.1
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    • pp.30-41
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    • 2007
  • Purpose: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with $^{18}F-2-deoxyglucose$ (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. Materials and Methods: The study group comprised 157 women patients (range: $28{\sim}78$ years old, $mean{\pm}SD=49.5{\pm}8.5$) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). Results: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion($4.79{\pm}3.32$ vs $1.45{\pm}0.44$, p=0.000, $3.08{\pm}2.85$ vs $0.30{\pm}0.43$, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b : 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding ($6.03{\pm}3.12$ vs $1.09{\pm}1.49$, p=0.000, $4.76{\pm}3.31$ vs $1.29{\pm}0.92$, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. Conclusion: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.