Evaluation of Left Atrial Volumes Using Multidetector Computed Tomography: Comparison with Echocardiography

권혜미,김상진,김태훈,이상민,홍유진,임세중 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.3

Objective: To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. Materials and Methods: Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. Results: The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3DVTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. Conclusion: A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography. Objective: To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. Materials and Methods: Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. Results: The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3DVTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. Conclusion: A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography.

Immune Checkpoint Inhibitors and Endocrine Disorders: A Position Statement from the Korean Endocrine Society

권혜미,Eun Roh,Chang Ho Ahn,Hee Kyung Kim,Cheol Ryong Ku,Kyong Yeun Jung,Ju Hee Lee,Eun Heui Kim,Sunghwan Suh,Sangmo Hong,하정훈,Jun Sung Moon,Jin Hwa Kim,Mi-kyung Kim,The Committee of Clinical Practice Gui 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.6

Immune checkpoint inhibitors (ICIs) including an anti-cytotoxic T-lymphocyte-associated antigen 4 inhibitor, anti-programmed cell death protein 1 (PD-1) inhibitors, and anti-PD-ligand 1 inhibitors are representative therapeutics for various malignancies. In oncology, the application of ICIs is currently expanding to a wider range of malignancies due to their remarkable clinical outcomes. ICIstarget immune checkpoints which suppress the activity of T-cells that are specific for tumor antigens, thereby allowing tumor cells to escape the immune response. However, immune checkpoints also play a crucial role in preventing autoimmune reactions. Therefore, ICIs targeting immune checkpoints can trigger various immune-related adverse events (irAEs), especially in endocrine organs. Considering the endocrine organs that are frequently involved, irAEs associated endocrinopathies are frequently life-threatening and have unfavorable clinical implications for patients. However, there are very limited data from large clinical trials that would inform the development of clinical guidelines for patients with irAEs associated endocrinopathies. Considering the current clinical situation, in which the scope and scale of the application of ICIs are increasing, position statements from clinical specialists play an essential role in providing the appropriate recommendations based on both medical evidence and clinical experience. As endocrinologists, we would like to present precautions and recommendations for the management of immune-related endocrine disorders, especially those involving the adrenal, thyroid, and pituitary glands caused by ICIs.

Preoperative echocardiographic evaluation of cardiac systolic and diastolic function in liver transplant recipients with diabetes mellitus: a propensity-score matched analysis

권혜미,정영일,김경선,정겨운,문영진,황규삼 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.4

Background: Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD). Methods: We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012–May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s’, e’ velocity, and E/e’ ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching. Results: DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s’ velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e’ velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e’ ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively. Conclusions: DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.

Serum Adiponectin and Progranulin Level in Patients with Benign Thyroid Nodule or Papillary Thyroid Cancer

권혜미,박세은,윤지섭,박철영 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.2

Background: Obesity is associated with thyroid cancer risk. Adiponectin has insulin-sensitizing and anti-inflammatory effects,while progranulin is associated with inflammation and tumorigenesis. We investigated serum adiponectin and progranulin levels inpatients with benign thyroid nodule (benign group) and papillary thyroid cancer (PTC; PTC group). The associations between theselevels and the clinicopathological features of PTC were evaluated. Methods: We included 157 patients who underwent thyroid surgery (17% of benign and 83% of PTC group). Clinicopathologicalfeatures including size, lymph node metastasis, extrathyroidal extension (ETE), multifocality, American Thyroid Association riskstratification were evaluated. Results: The age was 42.0 years, and 69% were female. Serum adiponectin and progranulin levels were 6.3 µg/mL and 101.5 ng/mLin the benign group and 5.4 µg/mL and 106.1 ng/mL in the PTC group, respectively (P=0.6 and P=0.4, respectively). Serum adiponectin levels showed no significant differences according to clinicopathological features of PTC. The proportions of patients withprimary tumor size >1 cm were 3%, 5%, 8%, and 8% according to serum progranulin level quartiles, respectively (P=0.03). Theproportions of patients with microscopic/gross ETE were 8%/0%, 9%/1%, 11%/1%, and 11%/2% according to serum progranulinlevel quartiles, respectively. Median serum progranulin level was significantly higher in patients with PTC >1 cm than in patientswith papillary thyroid microcarcinoma (P=0.04, 115.3 ng/mL and 104.7 ng/mL, respectively). Conclusion: Serum adiponectin and progranulin levels showed no significant difference between benign and PTC groups. Increasedserum progranulin levels were significantly associated with PTC >1 cm and microscopic and gross ETE.

Evaluation of the Cause of Internal Jugular Vein Obstruction on Head and Neck Contrast Enhanced 3D MR Angiography Using Contrast Enhanced Computed Tomography

권혜미,정태섭,서상현 대한자기공명의과학회 2011 Investigative Magnetic Resonance Imaging Vol.15 No.1

Purpose : To evaluate the cause of internal jugular vein (IJV) obstruction on contrast enhanced 3D MR angiography (CE-MRA) using contrast enhanced computed tomography (CE-CT). Materials and Methods : A total number of 30 patients were enrolled, who underwent both head and neck CE-MRA and CE-CT from 2005 to 2008. We defined obstruction group which had IJV obstruction and control group which had no IJV obstruction on CE-MRA. The following parameters were measured from axial images of CE-CT: 1)diameter of IJV; 2) distance between the styloid process and ipsilateral lateral mass of the atlas; 3) maximum area of lateral mass of the atlas. Each parameter was compared between obstruction group and control group. Results : The diameter of IJV and distance between the styloid process and lateral mass of the atlas at IJV obstruction side in obstruction group were 1.6 ± 1.0 mm and 4.1 ± 2.1 mm respectively, which resulted in statistical significance (p<0.01). The maximum area of lateral mass of the atlas at IJV obstruction side in obstruction group was 103.4 ± 25.3 mm2 which is significantly larger than in control group (p<0.05). Conclusion : We found that the cause of IJV obstruction on CE-MRA could be narrow space between the styloid process and the lateral mass of the atlas, which was related with asymmetric larger area of lateral mass of atlas.

대전류 및 용가재 직경에 따른 Al5083 아크 용접부 마그네슘 기화 및 기계적 성질

권혜미,박철호,홍인표,강남현,Kwon, Heimi,Park, Chul-Ho,Hong, In-Pyo,Kang, Namhyun 대한용접접합학회 2013 대한용접·접합학회지 Vol.31 No.6

The demand of LNG tank and the constituting material, i.e., the Al5083 thick plate, increased due to the rapid growth LNG market. To weld the Al5083 thick plate, the gas metal arc welding (GMAW) of high current is necessary to increase manufacturing productivity incurred by the multi pass welding. However, the arc welding vaporizes the volatile element such as magnesium (Mg). This phenomenon changes the Mg composition of the weld metal and the mechanical properties. The study investigated the weldability of Al5083 alloys after conducting high current GMAW. The Al5083 alloy was welded by using different size of welding wires and high current (800-950A). As the arc current increased from 800A to 950A, the mechanical strength decreased and the secondary dendrite arm spacing (SDAS) increased. Even though the arc current increased SDAS, the mechanical strength decreased due to the Mg loss in the weldment. The large diameter of welding wire decreased the dilution of the weld, therefore increasing the Mg content and the strength of the weld. For the reason, the content of Mg in welds was a major parameter to determine the mechanical property for the high current GMAW. For the arc current between 800A and 950A, the yield strength of the weldments showed a relationship with the weight percent of Mg content ($X_{Mg}$): Y.S = 27.9($X_{Mg}$)-11.

Cardiovascular dysfunction and liver transplantation

권혜미,황규삼 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.2

Cardiovascular complications have emerged as the leading cause of death after liver transplantation, particularly among those with advanced liver cirrhosis. Therefore, a thorough and accurate cardiovascular evaluation with clear comprehension of cirrhotic cardiomyopathy is recommended for optimal anesthetic management. However, cirrhotic patients manifest cardiac dysfunction concomitant with pronounced systemic hemodynamic changes, characterized by hyperdynamic circulation such as increased cardiac output, high heart rate, and decreased systemic vascular resistance. These unique features mask significant manifestations of cardiac dysfunction at rest, which makes it difficult to accurately evaluate cardiovascular status. In this review, we have summarized the current knowledge of heart and liver interactions, focusing on the usefulness and limitations of cardiac evaluation tools for identifying high-risk patients.

Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease

권혜미,김원구,장은경,김미진,박수연,전민지,김태용,류진숙,송영기,김원배 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.2

Background: Hyperthyroidism relapse in Graves disease after antithyroid drug (ATD) withdrawal is common; however, measuringthe thyrotropin receptor antibody (TRAb) at ATD withdrawal in order to predict outcomes is controversial. This study comparedmeasurement of thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) at ATDwithdrawal to predict relapse. Methods: This retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroidstimulatinghormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivityafter an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid functiontests and TSAb (TSAb group; n=35) or TBII (TBII group; n=39) every 3 to 6 months for 2 years after ATD withdrawal. Results: Twenty-eight patients (38%) relapsed for a median follow-up of 21 months, and there were no differences in baseline clinicalcharacteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal(67%) than patients with negative TSAb (17%; P=0.007). Relapse-free survival was shorter in TSAb-positive patients. In the TBIIgroup, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves diseaserelapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%. Conclusion: TSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb atATD withdrawal can assist with clinical decisions making for patients with Graves disease.

The Current Status of Hyperthyroidism in Korea

권혜미 대한내분비학회 2023 Endocrinology and metabolism Vol.38 No.4

None

Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma

권혜미,김미진,최윤미,장은경,전민지,김원구,김태용,송영기,송동은,백정환,홍석준,김원배 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.3

Background: Obesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC. Methods: This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles. Results: There were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26). Conclusion: In the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.