• Korean Journal of Radiology
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• 제22권8호
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• pp.1279-1288
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• 2021

Objective: To assess the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 treatment response algorithm (TRA) for the evaluation of hepatocellular carcinoma (HCC) treated with transarterial radioembolization. Materials and Methods: This retrospective study included patients who underwent transarterial radioembolization for HCC followed by hepatic surgery between January 2011 and December 2019. The resected lesions were determined to have either complete (100%) or incomplete (< 100%) necrosis based on histopathology. Three radiologists independently reviewed the CT or MR images of pre- and post-treatment lesions and assigned categories based on the LI-RADS version 2018 and the TRA, respectively. Diagnostic performances of LI-RADS treatment response (LR-TR) viable and nonviable categories were assessed for each reader, using histopathology from hepatic surgeries as a reference standard. Inter-reader agreements were evaluated using Fleiss κ. Results: A total of 27 patients (mean age ± standard deviation, 55.9 ± 9.1 years; 24 male) with 34 lesions (15 with complete necrosis and 19 with incomplete necrosis on histopathology) were included. To predict complete necrosis, the LR-TR nonviable category had a sensitivity of 73.3-80.0% and a specificity of 78.9-89.5%. For predicting incomplete necrosis, the LR-TR viable category had a sensitivity of 73.7-79.0% and a specificity of 93.3-100%. Five (14.7%) of 34 treated lesions were categorized as LR-TR equivocal by consensus, with two of the five lesions demonstrating incomplete necrosis. Interreader agreement for the LR-TR category was 0.81 (95% confidence interval: 0.66-0.96). Conclusion: The LI-RADS version 2018 TRA can be used to predict the histopathologic viability of HCCs treated with transarterial radioembolization.

• Korean Journal of Radiology
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• 제22권4호
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• pp.612-623
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• 2021

Objective: To evaluate the diagnostic performance of a deep learning algorithm for the automated detection of developmental dysplasia of the hip (DDH) on anteroposterior (AP) radiographs. Materials and Methods: Of 2601 hip AP radiographs, 5076 cropped unilateral hip joint images were used to construct a dataset that was further divided into training (80%), validation (10%), or test sets (10%). Three radiologists were asked to label the hip images as normal or DDH. To investigate the diagnostic performance of the deep learning algorithm, we calculated the receiver operating characteristics (ROC), precision-recall curve (PRC) plots, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared them with the performance of radiologists with different levels of experience. Results: The area under the ROC plot generated by the deep learning algorithm and radiologists was 0.988 and 0.988-0.919, respectively. The area under the PRC plot generated by the deep learning algorithm and radiologists was 0.973 and 0.618-0.958, respectively. The sensitivity, specificity, PPV, and NPV of the proposed deep learning algorithm were 98.0, 98.1, 84.5, and 99.8%, respectively. There was no significant difference in the diagnosis of DDH by the algorithm and the radiologist with experience in pediatric radiology (p = 0.180). However, the proposed model showed higher sensitivity, specificity, and PPV, compared to the radiologist without experience in pediatric radiology (p < 0.001). Conclusion: The proposed deep learning algorithm provided an accurate diagnosis of DDH on hip radiographs, which was comparable to the diagnosis by an experienced radiologist.

• Korean Journal of Radiology
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• 제23권1호
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• pp.52-59
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• 2022

Objective: To investigate whether the diagnostic performance of CT angiography (CTA) could be improved by modifying the conventional criterion (anastomosis site abnormality) to diagnose hepatic artery occlusion (HAO) after liver transplantation (LT) in suspected patients with Doppler ultrasound (US) abnormalities. Materials and Methods: One hundred thirty-four adult LT recipients (88 males and 46 females; mean age, 52.7 years) with suspected HAO on Doppler US (40 HAO and 94 non-HAO according to the reference standards) were included. We evaluated 1) abnormalities in the HA anastomosis, categorized as a cutoff, ≥ 50% stenosis at the anastomotic site, or diffuse stenosis at both graft and recipient sides around the anastomosis, and 2) abnormalities in the distal run-off, including invisibility or irregular, faint, and discontinuous enhancement. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the conventional (considering anastomosis site abnormalities alone) and modified CTA criteria (abnormalities in both the anastomosis site and distal run-off) for the diagnosis of HAO were calculated and compared using the McNemar test. Results: By using the conventional criterion to diagnose HAO, the sensitivity, specificity, PPV, NPV, and accuracy were 100% (40/40), 74.5% (70/94), 62.5% (40/64), 100% (70/70), and 82.1% (110/134), respectively. The modified criterion for diagnosing HAO showed significantly increased specificity (93.6%, 88/94) and accuracy (93.3%, 125/134) compared to that with the conventional criterion (p = 0.001 and 0.002, respectively), although the sensitivity (92.5%, 37/40) decreased slightly without statistical significance (p = 0.250). Conclusion: The modified criterion considering abnormalities in both the anastomosis site and distal run-off improved the diagnostic performance of CTA for HAO in suspected patients with Doppler US abnormalities, particularly by increasing the specificity.

• Korean Journal of Radiology
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• 제23권12호
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• pp.1290-1300
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• 2022

Objective: "Diagnostic yield," also referred to as the detection rate, is a parameter positioned between diagnostic accuracy and diagnosis-related patient outcomes in research studies that assess diagnostic tests. Unfamiliarity with the term may lead to incorrect usage and delivery of information. Herein, we evaluate the level of proper use of the term "diagnostic yield" and its related parameters in articles published in Radiology and Korean Journal of Radiology (KJR). Materials and Methods: Potentially relevant articles published since 2012 in these journals were identified using MEDLINE and PubMed Central databases. The initial search yielded 239 articles. We evaluated whether the correct definition and study setting of "diagnostic yield" or "detection rate" were used and whether the articles also reported companion parameters for false-positive results. We calculated the proportion of articles that correctly used these parameters and evaluated whether the proportion increased with time (2012-2016 vs. 2017-2022). Results: Among 39 eligible articles (19 from Radiology and 20 from KJR), 17 (43.6%; 11 from Radiology and 6 from KJR) correctly defined "diagnostic yield" or "detection rate." The remaining 22 articles used "diagnostic yield" or "detection rate" with incorrect meanings such as "diagnostic performance" or "sensitivity." The proportion of correctly used diagnostic terms was higher in the studies published in Radiology than in those published in KJR (57.9% vs. 30.0%). The proportion improved with time in Radiology (33.3% vs. 80.0%), whereas no improvement was observed in KJR over time (33.3% vs. 27.3%). The proportion of studies reporting companion parameters was similar between journals (72.7% vs. 66.7%), and no considerable improvement was observed over time. Conclusion: Overall, a minority of articles accurately used "diagnostic yield" or "detection rate." Incorrect usage of the terms was more frequent without improvement over time in KJR than in Radiology. Therefore, improvements are required in the use and reporting of these parameters.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5593-5596
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• 2014

Background: The objective of this study was to determine a diagnostic classification scheme using a decision tree based model. Materials and Methods: The study was conducted as a retrospective case-control study in Imam Khomeini hospital in Tehran during 2001 to 2009. Data, including demographic and clinical-pathological characteristics, were uniformly collected from 624 females, 312 of them were referred with positive diagnosis of breast cancer (cases) and 312 healthy women (controls). The decision tree was implemented to develop a diagnostic classification scheme using CART 6.0 Software. The AUC (area under curve), was measured as the overall performance of diagnostic classification of the decision tree. Results: Five variables as main risk factors of breast cancer and six subgroups as high risk were identified. The results indicated that increasing age, low age at menarche, single and divorced statues, irregular menarche pattern and family history of breast cancer are the important diagnostic factors in Iranian breast cancer patients. The sensitivity and specificity of the analysis were 66% and 86.9% respectively. The high AUC (0.82) also showed an excellent classification and diagnostic performance of the model. Conclusions: Decision tree based model appears to be suitable for identifying risk factors and high or low risk subgroups. It can also assists clinicians in making a decision, since it can identify underlying prognostic relationships and understanding the model is very explicit.

• 대한수의학회지
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• 제49권2호
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• pp.121-125
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• 2009

Paratuberculosis caused by Mycobacterium avium subspecies paratuberculosis (Mpt) is a chronic infectious enteric disease with deleterious impact on the performance in ruminants. In Korea, ELISA has been introduced to detect antibodies to Mpt in individual cattle. However, comparison study with ELISA has not been studied until now. In total, a panel of 899 serum samples obtained from dairy cattle was analyzed with two commercial ELISAs for Mpt to assess the performance. Two ELISAs employed in this study were both licensed worldwide. Two ELISAs applied onto same serum samples showed the moderate agreement (kappa value = 0.60). There was non-significant McNemar test (p = 0.0614) between two ELISA results indicating that each proportion detected by two kits did not differ. In addition, the percent agreement between two ELISA results was turned out to be 96.8% which interpreted excellent reproducibility. It was shown from this study that two ELISAs revealed moderate kappa agreement performance. The implication raised is that when ELISAs as diagnostics are used to detect Mpt in individual cattle, positive reaction by either ELISA should be interpreted as serologically Mpt positive due to presumed low sensitivity of ELISAs and their test agreement being less than 100%.

• Parasites, Hosts and Diseases
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• 제60권4호
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• pp.295-299
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• 2022

Malaria elimination and control require prompt and accurate diagnosis for treatment plan. Since microscopy and rapid diagnostic test (RDT) are not sensitive particularly for diagnosing low parasitemia, highly sensitive diagnostic tools are required for accurate treatment. Molecular diagnosis of malaria is commonly carried out by nested polymerase chain reaction (PCR) targeting 18S rRNA gene, while this technique involves long turnaround time and multiple steps leading to false positive results. To overcome these drawbacks, we compared highly sensitive cytochrome oxidase gene-based single-step multiplex reaction with 18S rRNA nested PCR. Cytochrome oxidase (cox) genes of P. falciparum (cox-III) and P. vivax (cox-I) were compared with 18S rRNA gene nested PCR and microscopy. Cox gene multiplex PCR was found to be highly specific and sensitive, enhancing the detection limit of mixed infections. Cox gene multiplex PCR showed a sensitivity of 100% and a specificity of 97%. This approach can be used as an alternative diagnostic method as it offers higher diagnostic performance and is amenable to high throughput scaling up for a larger sample size at low cost.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.4049-4057
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• 2016

Background: High-risk human papillomaviruses (HR-HPV), particularly types 16 and 18, have been found to play an important role in head and neck cancer, including oropharyngeal squamous cell carcinoma (OPSCC) and oral squamous cell carcinoma (OSCC). p16, a cell cycle inhibitor, has been postulated as a surrogate marker for HR-HPV, since p16 is aberrantly overexpressed in such lesions, especially in HR-HPV-positive OPSCC. However, p16 as a surrogate marker for HR-HPV infection in cancers of the oral cavity remains controversial. Objective: The objectives of the study were to investigate the expression of p16 and the presence of HR-HPV in OSCC and oral verrucous carcinoma (VC) and to determine if p16 could be used as a surrogate marker for HR-HPV. Materials and Methods: Forty one formalin-fixed, paraffin-embedded tissues of OSCC (n=37) or VC (n=4) with clinical and histopathologic data of each case were collected. Expression of p16 was determined by immunohistochemistry, focusing on both staining intensity and numbers of positive cells. The presence of HPV types 16 and 18 was detected by polymerase chain reaction (PCR). Descriptive statistics were employed to describe the demographic, clinical, and histopathologic parameters. Associations between p16 overexpression, HR-HPV and all variables were determined by Fisher's exact test, odds ratios (ORs) and corresponding 95% confidence intervals (CIs). In addition, the use of p16 as a surrogate marker for HR-HPV was analyzed by sensitivity and specificity tests. Results: p16 was overexpressed in 8/37 cases (21.6%) of OSCC and 2/4 cases (50%) of VC. HPV-16 was detected in 4/34 OSCC cases (11.8%) and HPV-18 was detected in 1/34 OSCC cases (2.9%). Co-infection of HPV-16/18 was detected in 1/4 VC cases (25%). Both p16 overexpression and HR-HPV were significantly associated with young patients with both OSCC and VC (p<0.05, OR 20, 95% CI 1.9-211.8; p<0.05, OR 23.3, 95% CI 2.4-229.7, respectively). p16 was able to predict the presence of HPV-16/18 in OSCC with 40% sensitivity and 79.3% specificity and in VC with 100% sensitivity and 66.7% specificity, respectively. Conclusions: p16 overexpression was found in 24.4% of both OSCC and VC. HR-HPV, regardless of type, was detected in 15.8% in cases of OSCC and VC combined. The results of sensitivity and specificity tests suggest that p16 can be used as a surrogate marker for HR-HPV in OSCC and VC.

• 대한임상검사과학회지
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• 제55권1호
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• pp.45-51
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• 2023

개 파보바이러스(canine parvovirus type 2, CPV-2)와 코로나바이러스(canine coronavirus, CCoV)는 개에서 위장관염을 일으키는 주요 병원체이다. 두 바이러스는 전염성과 이환율이 높고 특정한 치료법이 없어 신속 정확한 진단이 필요하다. 동물용 신속진단키트 (rapid diagnostic test, RDT)는 빠르고, 간편하여 진료현장에서 널리 활용되고 있다. 이에 본 연구에서는 성능평가를 통해 CPV-2/CCoV RDT의 임상적 유용성을 확인하고자 하였다. 성능평가 항목으로 최소검출한계(limit of detection, LoD), 교차반응, 간섭, 민감도, 특이도, 음성우도비(negative likelihood ratio, NLR), 카파통계량(kappa value, κ) 등을 확인하였다. 성능평가 결과, LoD는 CPV-2 9.7×10 50% tissue culture infections dose (TCID₅₀)/mL, CCoV 2.5×10² TCID₅₀/mL로 나타났다. 병원체 9종에 의한 교차반응과 간섭물질에 대한 간섭은 관찰되지 않았다. RDT는 두 바이러스의 검출에 있어 민감도 90.0%, 특이도 100.0%, NLR=0.1, κ=0.90으로 나타났다. 결론적으로 CPV-2/CCoV RDT는 높은 민감도, 특이도, κ와 낮은 NLR을 보여 선별검사로써 유용할 것으로 생각된다.

• 대한치과교정학회지
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• 제25권2호
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• pp.153-163
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• 1995

본 연구는 III급 부정 교합을 판별하는데 있어, 수평 부조화의 진단에 이용되는 여러 진단 항목들의 진단학적 효율과 타당성을 ROC analysis로 비교하는데 그 목적이 있다. ROC(Receiver Operating Characteristic) analysis는 연속적으로 변하는 cut-off value에서의 sensitivity와 1-specificity에 의해 그려지는 곡선으로서 진단 방법의 타당성을 결정하고, 여러 진단 방법들을 비교하는 분석법으로 알려져 있다. 부정교합자 496명을 대상으로 측모 두부 X-선 계측사진과 진단모형을 이용하여, 진단모형 계측을 통해 부정교합군을 분류하였으며, 이중 III급 부정 교합자는 245명이었다. 측모 두부 X-선계측사진에서 16개의 계측항목을 선정하였으며, 이 계측항목들과 III급 부정교합의 관계를 알아보고자 각도 계측항목에서는 $1^{\circ}$ 간격으로, 선계측항목에서는 1mm의 간격으로 sensitivity와 specificity를 구해 ROC curve를 그렸다. 그리고, 이 계측항목들의 직접적인 비교를 위해 ROC curve 아래의 면적을 계산해냈다. 결과는 다음과 같다. 1. III급 부정교합을 판별하는데 있어, "Wits" appraisal이 다른 계측 항목에 비해 더 나은 진단 효율을 보였다. 2. AB plane angle, ANB angle, App-Bpp distance, AF-BF distance, APDI, N perpendicular to A 와 Pog to N perpendicular의 차이, maxillomandibular differential도 높은 진단 가치를 보였다. 3. 하악골의 위치를 평가하는 계측항목은 중정도의 진단 효율을 보였다. 4. 상악골에 대한 계측항목은 III급 부정교합의 판별에 대한 진단 가치가 낮았다.