• Journal of the Korean Society of Radiology
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• v.18 no.4
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• pp.355-363
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• 2024

This study evaluated the clinical utility of Shear Wave Elastography(SWE) by analyzing the differences in elastic modulus and shear wave speed across various types of breast tissue and assessing inter-observer agreement. A breast phantom that included normal breast tissue, benign tumors, and malignant tumors was utilized, and ten radiologists participated, measuring the minimum, average, and maximum elastic modulus and shear wave speed for each tissue type. Analysis of differences between tissues was conducted using one-way ANOVA, and intra- and inter-observer agreement was assessed using the Intraclass Correlation Coefficient(ICC). The results demonstrated significant differences in the average values of elastic modulus and shear wave speed among the tissue types(p<0.001), with malignant tumor tissues showing the highest average values. Furthermore, the ICC analysis for elastic modulus ranged from 0.75 to 0.99 and for shear wave speed from 0.89 to 0.99, indicating high reproducibility and agreement. These findings suggest that SWE is a reliable tool with high reproducibility and specificity for the diagnosis of breast cancer.

• Journal of the Korean Society of Radiology
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• v.85 no.4
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• pp.714-726
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• 2024

Researchers have developed various algorithms utilizing artificial intelligence (AI) to automatically and objectively diagnose patterns and extent of pulmonary emphysema or interstitial lung diseases on chest CT scans. Studies show that AI-based quantification of emphysema on chest CT scans reveals a connection between an increase in the relative percentage of emphysema and a decline in lung function. Notably, quantifying centrilobular emphysema has proven helpful in predicting clinical symptoms or mortality rates of chronic obstructive pulmonary disease. In the context of interstitial lung diseases, AI can classify the usual interstitial pneumonia pattern on CT scans into categories like normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation. This classification accuracy is comparable to chest radiologists (70%-80%). However, the results generated by AI are influenced by factors such as scan parameters, reconstruction algorithms, radiation doses, and the training data used to develop the AI. These limitations currently restrict the widespread adoption of AI for quantifying pulmonary emphysema and interstitial lung diseases in daily clinical practice. This paper will showcase the authors' experience using AI for diagnosing and quantifying emphysema and interstitial lung diseases through case studies. We will primarily focus on the advantages and limitations of AI for these two diseases.

• Korean Journal of Radiology
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• v.25 no.7
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• pp.613-622
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• 2024

Objective: In Korea, radiology has been positioned towards the early adoption of artificial intelligence-based software as medical devices (AI-SaMDs); however, little is known about the current usage, implementation, and future needs of AI-SaMDs. We surveyed the current trends and expectations for AI-SaMDs among members of the Korean Society of Radiology (KSR). Materials and Methods: An anonymous and voluntary online survey was open to all KSR members between April 17 and May 15, 2023. The survey was focused on the experiences of using AI-SaMDs, patterns of usage, levels of satisfaction, and expectations regarding the use of AI-SaMDs, including the roles of the industry, government, and KSR regarding the clinical use of AI-SaMDs. Results: Among the 370 respondents (response rate: 7.7% [370/4792]; 340 board-certified radiologists; 210 from academic institutions), 60.3% (223/370) had experience using AI-SaMDs. The two most common use-case of AI-SaMDs among the respondents were lesion detection (82.1%, 183/223), lesion diagnosis/classification (55.2%, 123/223), with the target imaging modalities being plain radiography (62.3%, 139/223), CT (42.6%, 95/223), mammography (29.1%, 65/223), and MRI (28.7%, 64/223). Most users were satisfied with AI-SaMDs (67.6% [115/170, for improvement of patient management] to 85.1% [189/222, for performance]). Regarding the expansion of clinical applications, most respondents expressed a preference for AI-SaMDs to assist in detection/diagnosis (77.0%, 285/370) and to perform automated measurement/quantification (63.5%, 235/370). Most respondents indicated that future development of AI-SaMDs should focus on improving practice efficiency (81.9%, 303/370) and quality (71.4%, 264/370). Overall, 91.9% of the respondents (340/370) agreed that there is a need for education or guidelines driven by the KSR regarding the use of AI-SaMDs. Conclusion: The penetration rate of AI-SaMDs in clinical practice and the corresponding satisfaction levels were high among members of the KSR. Most AI-SaMDs have been used for lesion detection, diagnosis, and classification. Most respondents requested KSR-driven education or guidelines on the use of AI-SaMDs.

• Korean Journal of Radiology
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• v.25 no.7
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• pp.673-683
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• 2024

Objective: To evaluate the role of visual and quantitative chest CT parameters in assessing treatment response in patients with severe asthma. Materials and Methods: Korean participants enrolled in a prospective multicenter study, named the Precision Medicine Intervention in Severe Asthma study, from May 2020 to August 2021, underwent baseline and follow-up chest CT scans (inspiration/expiration) 10-12 months apart, before and after biologic treatment. Two radiologists scored bronchiectasis severity and mucus plugging extent. Quantitative parameters were obtained from each CT scan as follows: normal lung area (normal), air trapping without emphysema (AT without emph), air trapping with emphysema (AT with emph), and airway (total branch count, Pi10). Clinical parameters, including pulmonary function tests (forced expiratory volume in 1 s [FEV1] and FEV1/forced vital capacity [FVC]), sputum and blood eosinophil count, were assessed at initial and follow-up stages. Changes in CT parameters were correlated with changes in clinical parameters using Pearson or Spearman correlation. Results: Thirty-four participants (female:male, 20:14; median age, 50.5 years) diagnosed with severe asthma from three centers were included. Changes in the bronchiectasis and mucus plugging extent scores were negatively correlated with changes in FEV1 and FEV1/FVC (ρ = from -0.544 to -0.368, all P < 0.05). Changes in quantitative CT parameters were correlated with changes in FEV1 (normal, r = 0.373 [P = 0.030], AT without emph, r = -0.351 [P = 0.042]), FEV1/FVC (normal, r = 0.390 [P = 0.022], AT without emph, r = -0.370 [P = 0.031]). Changes in total branch count were positively correlated with changes in FEV1 (r = 0.349 [P = 0.043]). There was no correlation between changes in Pi10 and the clinical parameters (P > 0.05). Conclusion: Visual and quantitative CT parameters of normal, AT without emph, and total branch count may be effective for evaluating treatment response in patients with severe asthma.

• Korean Journal of Radiology
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• v.25 no.9
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• pp.798-806
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• 2024

Objective: Dual-layer CT (DLCT) can create virtual monochromatic images (VMIs) at various monochromatic X-ray energies, particularly at low keV levels, with high contrast-to-noise ratio. The purpose of this study was to assess the clinical feasibility of contrast-enhanced chest DLCT with a low keV VMI for preoperative breast cancer staging, in comparison to breast MRI. Materials and Methods: A total of 152 patients with 155 index breast cancers were enrolled in the study. VMIs were generated from contrast-enhanced chest DLCT at 40 keV and maximum intensity projection (MIP) with three-dimensional (3D) reconstruction was performed for both bilateral breast areas. Two radiologists reviewed in consensus the 3D MIP images of the chest DLCT with VMI and breast MRI in separate sessions with a 3-month wash-out period. The detection rate and mean tumor size of the index cancer were compared between the chest DLCT with VMI and breast MRI. Additionally, the agreement of tumor size measurement between the two imaging modalities were evaluated. Results: Of all index cancers, 84.5% (131/155) were detected in the chest DLCT with VMI, while 88.4% (137/155) were detected in the breast MRI (P = 0.210). The Bland-Altman agreement between the chest DLCT with VMI and breast MRI was a mean difference of -0.05 cm with 95% limits of agreement of -1.29 to 1.19 cm. The tumor size in the chest DLCT with VMI (2.3 ± 1.7 cm) was not significantly different from that in the breast MRI (2.4 ± 1.6 cm) (P = 0.106). Conclusion: The feasibility of chest DLCT with VMI was demonstrated for preoperative tumor staging in breast cancer patients, showing comparable cancer detectability and good agreement in tumor size measurement compared to breast MRI. This suggests that chest DLCT with VMI can serve as a potential alternative for patients who have contraindications to breast MRI.

• Journal of the Korean Society of Radiology
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• v.5 no.5
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• pp.303-308
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• 2011

Background/Aims : The increasing use of diagnostic and therapeutic interventional radiology calls for greater consideration of radiation exposure risk to radiologist and radiological technician, and emphasizes the proper system of radiation protection. This study was designed to assess the effect of a protective grass shield. Methods : A protective grass was following data depth, 0.8 cm; width, 100 cm; length, 100 cm, lead equivalent, 1.6 mmPb. The protective shield was located between the patient and the radiologist. Thirty patients (13 male and 17 female) undergoing interventional radiology between September 2010 and December 2010 were selected for this study. The dose of radiation exposure was recorded with or without the protective grass shield at the level of the head, chest, and pelvis. The measurement was made at 50 cm and 150 cm from the radiation source. Results : The mean patient age was 69 years. The mean patient height and weight was $159.7{\pm}6.7$ cm and $60.3{\pm}5.9$ kg, respectively. The mean body mass index (BMI) was $20.5{\pm}3.0$ kg/m2. radiologists received $1530.2{\pm}550.0$ mR/hr without the protective lead shield. At the same distance, radiation exposure was significantly reduced to $50.3{\pm}85.2$ mR/hr with the protective lead shield (p-value<0.0001). The radiation exposure to radiologist and radiological technician was significantly reduced by the use of a protective lead shield (p value <0.0001). The amount of radiation exposure during interventional radiology was related to the patient' BMI (r=0.749, p=0.001). Conclusions : This protective shield grass is effective in protecting radiologist and radiological technician from radiation exposure.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.133-143
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• 2013

Purpose : To evaluate and compare the accuracy of magnetic resonance imaging (MRI) and ultrasound (US) for detection and estimation of invasion depth of colorectal carcinoma (CRC) by correlation with histopathologic findings in vitro, and to find out the best MR pulse sequence for accurate delineation of tumor from surrounding normal tissue. Materials and Methods: Resected specimens of CRC from 45 patients were examined about tumor detectability and invasion depth of US using high frequency (5-17 MHz) linear transducer in a tube filled with normal saline and MRI in a 8-channel quadrate head coil. The institutional review board approved this study and informed consent was waived. MRI with seven pulse sequences of in- and out-of-phases gradient echo T1 weighted images, fast spin echo T2 weighted image and its fat suppression image, fast imaging employing steady-state acquisition (FIESTA) and its fat suppression image, and diffusion weighted image (DWI) were performed. In each case, both imaging findings of MRI and US were evaluated independently for detection and estimation of invasion depth of tumor by consensus of two radiologists and were compared about diagnostic accuracy according to the histopathologic findings as reference standard. Seven MR pulse sequences were evaluated on the point of accurate delineation of tumor from surrounding normal tissue in each specimen. Results: In specimens of CRC, both imaging modalities of MRI (91.1%) and US (86.7%) showed relatively high diagnostic accuracy to detect tumor and evaluate invasion depth of tumor. In early CRC, diagnostic accuracy of US was 87.5% and that of MRI was 75.0%. There was no statistically significant difference between two imaging modalities (p > 0.05). The best pulse sequence among seven MR sequences for accurate delineation of tumor from surrounding normal tissue in each specimen of CRC was fast spin echo T2 weighted image. Conclusion: MRI and US show relatively high diagnostic accuracy to detect tumor and evaluate invasion depth of resected specimen of CRC. The most excellent pulse sequence of MRI for accurate delineation of tumor from surrounding normal tissue in CRC is fast spin echo T2 weighted image.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.110-122
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• 2013

Purpose : To compare the image quality and ligament traceability in ankle images obtained using Volume Isotropic Turbo Spin Echo Acquisition (VISTA) MRI with and without fat suppression. Materials and Methods: The signal-to-noise ratios (SNRs) in images from a phantom and from the ankle of a volunteer were compared. Ten ankles from 10 non-symptomatic volunteers were imaged for comparisons of contrast ratio (CR) and ligament traceability. All examinations were performed using VISTA sequences with and without fat suppression on a 3T MRI scanner. The SNRs were obtained from images with subjects and without subjects (noise-only). Contrast ratios from images of the 10 ankles were acquired between fluid and tendon (F-T), F-cartilage (C), F-ligament (L), fat (f)-T, f-C and f-L. Two musculoskeletal radiologists independently scored the traceability of 7 ligaments, in sagittal, axial and coronal images respectively, based on a 4-point scale (1 as not traceable through 4 as clearly traceable). The Wilcoxon signed-rank test was used to compare the CR. Fisher's exact test and Pearson's chi-squared test were used to compare the ligament traceability. Results: The SNRs did not differ significantly between the two sequences except in bone marrow. VISTA SPAIR showed the higher CR only in F-T (p = 0.04), whereas VISTA showed higher CR in f-T (p = 0.005), f-C (p = 0.005) and f-L (p = 0.005). The calcaneofibular ligament traceability with VISTA was superior to that obtained with VISTA SPAIR (p < 0.05) in all planes. Conclusion: VISTA showed significant superiority to VISTA SPAIR in tracing CFL due to the superior CR between fat and ligament.

• Investigative Magnetic Resonance Imaging
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• v.22 no.1
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• pp.1-9
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• 2018

Purpose: This study was designed to optimize the flip angle (FA) and scan timing of the hepatobiliary phase (HBP) using the 3D T1-weighted, gradient-echo (GRE) imaging with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique on gadoxetic acid-enhanced 3T liver MR imaging. Materials and Methods: Sixty-two patients who underwent gadoxetic acid-enhanced 3T liver MR imaging were included in this study. Four 3D T1-weighted GRE imaging studies using the CAIPIRINHA technique and FAs of $9^{\circ}$ and $13^{\circ}$ were acquired during HBP at 15 and 20 min after intravenous injection of gadoxetic acid. Two abdominal radiologists, who were blinded to the FA and the timing of image acquisition, assessed the sharpness of liver edge, hepatic vessel clarity, lesion conspicuity, artifact severity, and overall image quality using a five-point scale. Quantitative analysis was performed by another radiologist to estimate the relative liver enhancement (RLE) and the signal-to-noise ratio (SNR). Statistical analyses were performed using the Wilcoxon signed rank test and one-way analysis of variance. Results: The scores of the HBP with an FA of $13^{\circ}$ during the same delayed time were significantly higher than those of the HBP with an FA of $9^{\circ}$ in all the assessment items (P < 0.01). In terms of the delay time, images at the same FA obtained with a 20-min-HBP showed better quality than those obtained with a 15-min-HBP. There was no significant difference in qualitative scores between the 20-min-HBP and the 15-min-HBP images in the non-liver cirrhosis (LC) group except for the hepatic vessel clarity score with $9^{\circ}$ FA. In the quantitative analysis, a statistically significant difference was found in the degree of RLE in the four HBP images (P = 0.012). However, in the subgroup analysis, no significant difference in RLE was found in the four HBP images in either the LC or the non-LC groups. The SNR did not differ significantly in the four HBP images. In the subgroup analysis, 20-min-HBP imaging with a $13^{\circ}$ FA showed the highest SNR value in the LC-group, whereas 15-min-HBP imaging with a $13^{\circ}$ FA showed the best value of SNR in the non-LC group. Conclusion: The use of a moderately high FA improves the image quality and lesion conspicuity on 3D, T1-weighted GRE imaging using the CAIPIRINHA technique on gadoxetic acid, 3T liver MR imaging. In patients with normal liver function, the 15-min-HBP with a $13^{\circ}$ FA represents a feasible option without a significant decrease in image quality.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.152-160
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• 2009

Purpose : To intra-individually compare diagnostic accuracy of high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) with computed tomography angiography (CTA) and digital subtraction angiography (DSA) for the assessment of supraaortic steno-occlusive disease. Materials and Methods : Twenty-eight patients (20 men, 8 women, 53-79 years of age) underwent supraaortic CE-MRA, CTA and DSA. CE-MRA was performed on two 1.5T MR scanners (voxel dimension: $0.66{\times}0.66{\times}1.1$ or $1.2\;mm^3$), and CTA on 64-slice CT scanners (voxel dimension: $0.42{\times}0.42{\times}0.63\;mm^3$). All the three examinations were completed within 40 days (median 19 days; range 1-40 days). Retrospective evaluation and measurement of diameter of 6 extracranial and 9 intracranial arterial segments was done by 2 experienced radiologists. Results: A total of 420 arterial segments were examined by CE-MRA, CTA and DSA. On DSA, 34 stenoocclusive lesions were noted at extracranial (n= 19) and intracranial (n = 15) vessels. For extracranial stenosis greater than 70%, sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 94.7%, 98.7%, 90.0% and 99.3% on CE-MRA, and 94.7%, 99.3%, 94.7% and 99.3% on CTA. For intracranial stenosis greater than 50%, sensitivity; specificity, PPV and NPV were 93.3%, 98.3%, 77.8%and 99.6% on CE-MRA, and 86.7%, 97.9%, 72.2% and 99.1 % on CTA, with DSA as the standard of reference. Conclusion : Supraaortic CE-MRA is as reliable as CTA in depicting the arterial stenosis, and is effective in screening of significant stenosis of both extracranial and intracranial arterial stenosis.