Early quantification of the therapeutic efficacy of the vascular disrupting agent, CKD-516, using dynamic contrast-enhanced ultrasonography in rabbit VX2 liver tumors

주이진,김정훈,이정민,최진우,한준구,최병인 대한초음파의학회 2014 ULTRASONOGRAPHY Vol.33 No.1

Purpose: To evaluate the usefulness of dynamic contrast-enhanced ultrasonography (DCE-US) in the early quantification of hemodynamic change following administration of the vascular disrupting agent (VDA) CKD-516 using a rabbit VX2 liver tumor model. Methods: This study was approved by our institutional animal care and use committee. Eight VX2 liver-tumor-bearing rabbits were treated with intravenous CKD-516, and all underwent DCE-US using SonoVue before and again 2, 4, 6, and 24 hours following their treatment. The tumor perfusion parameters were obtained from the time-intensity curve of the DCE-US data. Repeated measures analysis of variance was performed to assess any significant change in tumor perfusion over time. Relative changes in the DCE-US parameters between the baseline and follow-up assessments were correlated with the relative changes in tumor size over the course of seven days using Pearson correlation. Results: CKD-516 treatment resulted in significant changes in the DCE-US parameters, including the peak intensity, total area under the time-intensity curve (AUCtotal), and AUC during wash-out (AUCout) over time (P<0.05). Pairwise comparison tests revealed that the AUCtotal and AUC during wash-in (AUCin) seen on the two-hour follow-up were significantly lower than the baseline values (P<0.05). However, none of early changes in the DCE-US parameters until 24-hour follow-up showed a significant correlation with the relative changes in tumor size during seven days after CKD-516 treatment. Conclusion: Our results suggest that a novel VDA (CKD-516) can cause disruption of tumor perfusion as early as two hours after treatment and that the therapeutic effect of CKD-516 treatment can be effectively quantified using DCE-US.

Fibroblastic Type Osteosarcoma of the Ulna: a Case Report of a Tumor in a Rare Location with Atypical Imaging Findings

주이진,최정아,정진행,오주한,홍성환,강흥식 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.1

The ulna is a rare site of origin for osteosarcoma, and purely osteolytic osteosarcomas are uncommonly noted on conventional radiographs. We present a patient with a lytic lesion of the distal ulna for which imaging findings suggested an aneurysmal bone cyst. The lesion was histologically confirmed to be a fibroblastic osteosarcoma. The ulna is a rare site of origin for osteosarcoma, and purely osteolytic osteosarcomas are uncommonly noted on conventional radiographs. We present a patient with a lytic lesion of the distal ulna for which imaging findings suggested an aneurysmal bone cyst. The lesion was histologically confirmed to be a fibroblastic osteosarcoma.

The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions

주이진 대한초음파의학회 2015 ULTRASONOGRAPHY Vol.34 No.4

Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both asa diagnostic technique and in the course of treatment. Since IOUS involves direct-contactimaging of the target organ, it can provide high spatial resolution without interference from thesurrounding structures. Therefore, IOUS may improve the detection, characterization, localization,and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable ofproviding interactive information and valuable guidance in a range of procedures. Recently,contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attractedincreasing interest and are expected to lead to the broader implementation of IOUS. Herein,we review the various applications of IOUS in the diagnosis and management of focal hepaticlesions.

Clinical significance of isolated macrocalcifications detected by ultrasonography

주이진,백정환 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.4

We read with great interest the article published by Paik et al. entitled "CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography" in Ultrasonography [1]. The authors evaluated isolated macrocalcifications (IMs) in the thyroid gland using ultrasonography (US) and computed tomography (CT). They defined IMs as isolated, calcified thyroid nodules with complete posterior acoustic shadowing in which no solid component was obviously identified within the nodules on US [1]. Their concern about IMs was that previous studies have either not clearly defined IMs [2] or categorized them incorrectly (as rim or peripheral calcifications) [3,4]. Regarding this issue, the authors clearly showed the nature of IMs on CT. Among the 20 IMs, 90% (18 of 20) showed central calcification and 10% (2 of 20) showed peripheral calcifications. Therefore, the authors argued that thyroid nodules with IMs detected on US should not be classified as rim or peripheral calcifications. The risk of malignancy of IMs seems to be 10%-20% [5]. The classification of the US lexicon plays an important role in the risk stratification of thyroid nodules for malignancy [1]. IMs are categorized as intermediate suspicion nodules in the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) [6] and as moderately suspicious nodules in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) [7]. However, this has not been specified in the risk stratification of thyroid nodules in other thyroid society guidelines [1]. We appreciate the valuable results shown by the authors in this study. The results are very interesting and clinically useful. However, we have several questions and comments. First, regarding terminology, the word "isolated" is not very intuitive. We suggest alternative terms, such as "totally calcified nodule" or "macrocalcified nodule without a solid component." However, we recognize that these terms might not fully represent the nature of IMs. Second, we are concerned about serial changes of IMs. As the authors noted that a completely calcified nodule might increase the risk of a nondiagnostic fine-needle aspiration (FNA) biopsy result, regular follow-ups are especially important. Third, as core-needle biopsy (CNB) has shown a higher diagnostic efficacy than FNA in thyroid nodules with IMs on US [8], we believe that the study would have been more meaningful if it had included pathologic results from CNB of these thyroid nodules. Finally, regarding the relatively high nondiagnostic and/or biopsy failure rate of IMs, the malignancy risk of IMs may be higher than has been previously reported. In conclusion, the findings of this study suggest that IMs are clinically significant. We appreciate these observations and propose the need to develop more intuitive terminology for IMs and to evaluate their serial changes on US.

담관암 영상 진단의 최신 지견

주이진 대한영상의학회 2019 대한영상의학회지 Vol.80 No.3

담관암은 광범위한 영상학적, 조직학적, 임상적 특성 및 치료 방법을 가진 질병군이다. 현재영상 검사는 담관암의 발견, 특성 평가, 병기 결정 및 절제 가능성 평가 등에 중요한 역할을담당하고 있다. 본 종설에서는 간내 및 간문주변부 담관암의 영상 소견 및 판독에 고려할 사항들에 대해 설명하고 담관암의 분류 체계, 종양 발생 과정, 전암 병변 및 치료 방법 접근 등에 대한 최신 개념을 소개하고자 한다. Cholangiocarcinoma is a disease entity with a wide spectrum of imaging, histological, and clinical features as well as treatment options. At present, imaging studies are essential for the detection, characterization, staging, and resectability assessment of cholangiocarcinoma. This review article describes the imaging features of intrahepatic and perihilar cholangiocarcinoma and the considerations for interpretation of these features. In addition, we introduce the latest concepts regarding the classification system, carcinogenesis process, premalignant lesions, and treatment approaches for cholangiocarcinoma.

Cancer Stem Cells in Primary Liver Cancers: Pathological Concepts and Imaging Findings

주이진,김혜령,이정민 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.1

There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth. Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes. Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations. In this article, we reviewed the recent concepts of CSCs in the development of primary liver cancers, focusing on their pathological and radiological findings. Awareness of the pathological concepts and imaging findings of primary liver cancers with features of CSCs is critical for accurate diagnosis, prediction of outcome, and appropriate treatment options for patients.

Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know

주이진,김효철,김경민,팽진철 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.2

Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.

Assessment of liver fibrosis using 2-dimensional shear wave elastography: a prospective study of intra- and interobserver repeatability and comparison with point shear wave elastography

유정인,이정민,주이진,윤정희 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.1

Purpose: The purpose of this study was to prospectively investigate the intra- and inter-observer repeatability of a new 2-dimensional (2D) shear wave elastography (SWE) technique (S-Shearwave Imaging) for assessing liver fibrosis in chronic liver disease patients, and to compare liver stiffness measurements (LSMs) made using 2D-SWE with those made using point SWE (pSWE). Methods: This prospective study received institutional review board approval and informed consent was obtained from all patients. Fifty-three chronic liver disease patients were randomly allocated to group 1 (for intra-observer repeatability [n=33]) or group 2 (for inter-observer repeatability [n=20]). In group 1, two 2D-SWE sessions and one pSWE sessions were performed by one radiologist. In group 2, one 2D-SWE session and one pSWE session were performed by the aforementioned radiologist, and a second 2D-SWE session was performed by another radiologist. The intraclass correlation coefficient (ICC) was used to assess intra- and interobserver reliability. LSMs obtained using 2D-SWE and pSWE were compared and correlated using the paired t test and Pearson correlation coefficient, respectively. Results: LSMs made using 2D-SWE demonstrated excellent intra- and inter-observer repeatability (ICC, 0.997 [95% confidence interval, 0.994 to 0.999]) and 0.995 [0.988 to 0.998], respectively). LSMs made using 2D-SWE were significantly different from those made using pSWE (2.1±0.6 m/sec vs. 1.9±0.6 m/sec, P<0.001), although a significant correlation existed between the 2D-SWE and pSWE LSMs (rho=0.836, P<0.001). Conclusion: S-Shearwave Imaging demonstrated excellent intra- and inter-observer repeatability, and a strong correlation with pSWE measurements of liver stiffness. However, because of the significant difference between LSMs obtained using 2D-SWE and pSWE, these methods should not be used interchangeably.

Reproducibility of ultrasound attenuation imaging for the noninvasive evaluation of hepatic steatosis

유정인,이정민,주이진,이동호,윤정희,강효진,안수좌 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.2

Purpose: The purpose of this study was to evaluate the intra-observer reproducibility of ultrasound attenuation imaging (ATI) for the noninvasive assessment of hepatic steatosis in patients with suspected hepatic steatosis and the inter-observer reproducibility in asymptomatic volunteers. Methods: This prospective study was approved by our institutional review board and informed consent was obtained from all patients. In group 1, composed of patients with suspected hepatic steatosis (n=143), one abdominal radiologist performed gray-scale ultrasonography and two sessions of ATI. In group 2, composed of healthy volunteers (n=18), three independent sessions of ATI were performed by three abdominal radiologists. The visual degree of hepatic steatosis in all study subjects was graded on a 4-point scale by two independent reviewers using gray-scale ultrasonography. Thereafter, the attenuation coefficient (AC) was correlated with the degree of hepatic steatosis using Spearman rank correlation analysis. Intra-class correlation coefficients (ICCs) were used to assess the intra-observer (group 1) and inter-observer reproducibility (group 2) of ATI measurements. Results: For the intra-observer reproducibility of ATI, the ICC was 0.929 (95% confidence interval [CI], 0.901 to 0.949), and the coefficient of variation was 7.1%. Inter-observer reproducibility of ATI measurements showed an ICC of 0.792 (95% CI, 0.549 to 0.916). The AC showed a significant correlation with the visual grade of hepatic steatosis for both reviewers (rho, 0.780 and 0.695; P<0.001, respectively). Conclusion: ATI showed high intra- and inter-observer reproducibility in the assessment of hepatic steatosis.

Assessment of the inter-platform reproducibility of ultrasound attenuation examination in nonalcoholic fatty liver disease

전선경,이정민,주이진,윤정희 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.2

Purpose: This study aimed to assess the inter-platform reproducibility of ultrasound attenuation examination in patients with nonalcoholic fatty liver disease (NAFLD).Methods: Between March 2021 and April 2021, patients with clinically suspected or known NAFLD were prospectively enrolled; each patient underwent ultrasound attenuation examinations with three different platforms (Attenuation Imaging [ATI], Canon Medical System; Tissue Attenuation Imaging [TAI], Samsung Medison; and Ultrasound-Guided Attenuation Parameter [UGAP], GE Healthcare) on the same day. The mean attenuation coefficient (AC) values of the three platforms were compared using repeated-measures analysis of variance with the Bonferroni correction. To evaluate inter-platform reproducibility, the AC values obtained for each platform were compared using Bland-Altman analysis with the calculation of 95% limits of agreement (LOA), intraclass correlation coefficients (ICCs), and coefficients of variation (CVs).Results: Forty-six patients (23 men; mean age±standard deviation, 52.3±12.4 years) were enrolled. The mean AC values showed significant differences among the three platforms (0.75±0.12, 0.80±0.11, and 0.74±0.09 dB/cm/MHz for ATI, TAI, and UGAP, respectively; P<0.001). For inter-platform reproducibility, the 95% LOAs were -0.22 to 0.11 dB/cm/MHz between ATI and TAI, -0.17 to 0.18 dB/cm/MHz between ATI and UGAP, and -0.08 to 0.20 dB/cm/MHz between TAI and UGAP, respectively. The pairwise ICCs were 0.790-0.797 in terms of absolute agreement among the three platforms; the CVs were 8.23%-9.47%.Conclusion: The AC values obtained from different ultrasound attenuation examination platforms showed significant differences, with significant inter-platform variability. Therefore, the AC values measured using different ultrasound attenuation examination techniques should not be used interchangeably for longitudinal follow-up of patients with NAFLD.