• The Journal of the Society of Stroke on Korean Medicine
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• v.13 no.1
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• pp.43-51
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• 2012

Object : The purpose of this study was to evaluate the relationship between pattern identification (PI) and stroke risk factors, such as hypertension, diabetes mellitus, dyslipidemia, stroke history, obesity, abdominal obesity and metabolic syndrome. Methods : 46 patients with acute ischemic stroke were recruited from May 2012 to November, 2012. We analyzed the data of 32 patients, and pattern identification was identified by resident and specialist of Korean medicine. We analized patient's PI and risk factor by Fisher's exact test. Results : We found that Dampness-phlegm group was more related with patient's metabolic syndrome than non Dampness-Phlegm group. And Yin deficiency group had less relationship with patient's metabolic syndrome, obesity, abdominal obesity and dyslipidemia than non Yin deficiency group. Conclusions : According to the analysis, these results provide evidence for relationship between the Dampness-phlegm group, Yin deficiency and metabolic syndrome.

• 지역과문화
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• v.5 no.1
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• pp.65-84
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• 2018

The purpose of this study is to develop education programs for effective education of Jeong-gan-bo. Jeong-gan-bo is a unique piece of music made during King Sejong's reign. Starting in the third grade elementary school, Jeong-gan-bo begins to develop. If you fail to understand Jeongganbo in lower grades, you often give up scores of music in a more detailed and complicated manner. This is why we need a customized education program for the first time in lower grades. For this purpose, the basic process of understanding the Jeongganbo is understood to be played as a traditional play. This study consists of the elementary school the 3rd grade scenario. This study consists of the second - grade class scenarios for the 3rd grade elementary school students, the curriculum is centered on the curriculum, which is currently in the 3rd grade curriculum, curriculum in 2009. The program learns to play the rhythm of the 1st phase, the code of the 2nd stage of Jeong-dan, and play the rhythm through play through play. Step 1 is not only visually recognizable, but also a direct sign of the code. The second phase consists of the basic composition of Jeongganbo, through the basic composition of Jangdan, and learns the exact rhythm of Jeongganbo. The results of the study can be divided into meaningful meaning in terms of educational significance and educational content development in terms of educational significance. The methods used to understand the exercises and play games were effective in understanding the contents of Jeongganbo, and also meaningful to the role of traditional music in the context of various programs.

• The Korean Journal of Applied Statistics
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• v.36 no.5
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• pp.415-445
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• 2023

Oftentimes, the time dependent treatment covariate and the time dependent confounders exist in observation studies. It is an important problem to correctly adjust for the time dependent confounders in the propensity score analysis. Recently, In the survival data, Hade et al. (2020) used a propensity score matching method to correctly estimate the treatment delay effect when the time dependent confounder affects time to the treatment time, where the treatment delay effects is defined to the delay in treatment reception. In this paper, we proposed the Cox model based marginal structural model (Cox-MSM) framework to estimate the treatment delay effect and conducted extensive simulation studies to compare our proposed Cox-MSM with the propensity score matching method proposed by Hade et al. (2020). Our simulation results showed that the Cox-MSM leads to more exact estimate for the treatment delay effect compared with two sequential matching schemes based on propensity scores. Example from study in treatment discontinuation in conjunction with simulated data illustrates the practical advantages of the proposed Cox-MSM.

• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1071-1080
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• 2022

Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.379-394
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• 2020

Purpose To design a scoring system to predict malignancy of additional MRI-detected lesions in breast cancer patients. Materials and Methods Eighty-six lesions (64 benign and 22 malignant) detected on preoperative MRI of 68 breast cancer patients were retrospectively included. The clinico-radiologic features were correlated with the histopathologic results using the Student's t-test, Fisher's exact test, and logistic regression analysis. The scoring system was designed based on the significant predictive features of malignancy, and its diagnostic performance was compared with that of the Breast Imaging-Reporting and Data System (BI-RADS) category. Results Lesion size ≥ 8 mm (p < 0.001), location in the same quadrant as the primary cancer (p = 0.005), delayed plateau kinetics (p = 0.010), T2 isointense (p = 0.034) and hypointense (p = 0.024) signals, and irregular mass shape (p = 0.028) were associated with malignancy. In comparison with the BI-RADS category, the scoring system based on these features with suspicious non-mass internal enhancement increased the diagnostic performance (area under the receiver operating characteristic curve: 0.918 vs. 0.727) and detected three false-negative cases. With this scoring system, 22 second-look ultrasound examinations (22/66, 33.3%) could have been avoided. Conclusion The scoring system based on the lesion size, location relative to the primary cancer, delayed kinetic features, T2 signal intensity, mass shape, and non-mass internal enhancement can provide a more accurate approach to evaluate MRI-detected lesions in breast cancer patients.

• Korean Journal of Radiology
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• v.23 no.5
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• pp.548-554
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• 2022

Objective: To evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA). Materials and Methods: This retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure's selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher's exact test, independent sample t test, Wilcoxon signed-rank test, or Mann-Whitney test. Results: All patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31; p > 0.999). No technical problem-related conversion from TRA to TFA occurred. The clinical success rate was 85% (11/13) in patients with TRA, and 89% (16/18) in patients with TFA for follow-up > 2 weeks post-PAE (median, 3 months) (p > 0.999). The median procedure time was similar in both groups (TRA, 81 minutes vs. TFA, 94 minutes; p = 0.570). No significant dose differences were found between the TRA and TFA groups in the dose-area product (median Gycm², 95 [range, 44-255] for TRA and 84 [34-255] for TFA; p = 0.678) or cumulative air kerma (median mGy, 609 [236-1584] for TRA and 634 [217-1594] for TFA; p = 0.551). No major adverse events occurred in either of the groups. Conclusion: PAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.

• 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.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.271-279
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• 2022

Objective: To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children. Materials and Methods: Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test. Results: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group. Conclusion: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1185-1193
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• 2021

Objective: Clear cell sarcoma of the kidney (CCSK) is the second-most common but extremely rare primary renal malignancy in children after Wilms' tumor. The aims of this study were to evaluate the imaging features that could distinguish between CCSK and Wilms' tumor and to assess the features with diagnostic value for identifying CCSK. Materials and Methods: We reviewed the initial contrast-enhanced abdominal-pelvic CT scans of children with CCSK and Wilms' tumor between 2010 to 2019. Fifty-eight children (32 males and 26 females; age, 0.3-10 years), 7 with CCSK, and 51 with Wilms' tumor, were included. The maximum tumor diameter, presence of engorged perinephric vessels, maximum density of the tumor (Tmax) of the enhancing solid portion, paraspinal muscle, contralateral renal vein density, and density ratios (Tmax/muscle and Tmax/vein) were analyzed on the renal parenchymal phase of contrast-enhanced CT. Fisher's exact tests and Mann-Whitney U tests were conducted to analyze the categorical and continuous variables, respectively. Logistic regression and receiver operating characteristic curve analyses were also performed. Results: The age, sex, and tumor diameter did not differ between the two groups. Engorged perinephric vessels were more common in patients in the CCSK group (71% [5/7] vs. 16% [8/51], p = 0.005). Tmax (median, 148.0 vs. 111.0 Hounsfield unit, p = 0.004), Tmax/muscle (median, 2.64 vs. 1.67, p = 0.002), and Tmax/vein (median, 0.94 vs. 0.59, p = 0.002) were higher in the CCSK compared to the Wilms' group. Multiple logistic regression revealed that engorged vessels (odds ratio 13.615; 95% confidence interval [CI], 1.770-104.730) and Tmax/muscle (odds ratio 5.881; 95% CI, 1.337-25.871) were significant predictors of CCSK. The cutoff values of Tmax/muscle (86% sensitivity, 77% specificity) and Tmax/vein (71% sensitivity, 86% specificity) for the diagnosis of CCSK were 1.97 and 0.76, respectively. Conclusion: Perinephric vessel engorgement and greater tumor enhancement (Tmax/muscle > 1.97 or Tmax/vein > 0.76) are helpful for differentiating between CCSK and Wilms' tumor in children aged below 10 years.

• Korean Journal of Radiology
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• v.20 no.1
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• pp.58-68
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• 2019

Objective: To compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques. Materials and Methods: Three blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics. Results: Forty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0-6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001). Conclusion: Invasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.