Journal of Yeungnam Medical Science

Original article

Diagnostic performance of F-18 FDG PET or PET/CT for detection of recurrent gastric cancer: a systematic review and meta-analysis: Chang In Choi, Jae Kyun Park, Tae Yong Jeon, Dae-Hwan Kim; J Yeungnam Med Sci. 2023;40(Suppl):S37-S46. Published online August 17, 2023; DOI: https://doi.org/10.12701/jyms.2023.00220

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Abstract PDF: Background
This systematic review and meta-analysis investigated the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of disease recurrence after curative resection of gastric cancer.
Methods
The PubMed and Embase databases, from the earliest available date of indexing through November 30, 2019, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT to detect recurrent disease after gastric cancer surgery.
Results
Across 17 studies (1,732 patients), the pooled sensitivity for F-18 FDG PET or PET/CT was 0.82 (95% confidence interval [CI], 0.74–0.88) with heterogeneity of I2=76.5 (p<0.001), and the specificity was 0.86 (95% CI, 0.78–0.91) with heterogeneity of I2=94.2 (p<0.001). Likelihood ratio (LR) tests gave an overall positive LR of 6.0 (95% CI, 3.6–9.7) and negative LR of 0.2 (95% CI, 0.14–0.31). The pooled diagnostic odds ratio was 29 (95% CI, 13–63). The summary receiver operating characteristic curve indicates that the area under the curve was 0.91 (95% CI, 0.88–0.93).
Conclusion
The current meta-analysis showed good sensitivity and specificity of F-18 FDG PET or PET/CT for detecting recurrent disease after curative resection of gastric cancer despite heterogeneity in ethnicity, recurrence rate, histology, and interpretation method.

Review article

Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review: Chun Geun Lim, Myong Hun Hahm, Hui Joong Lee; J Yeungnam Med Sci. 2023;40(2):136-145. Published online January 10, 2023; DOI: https://doi.org/10.12701/jyms.2022.00689

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Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.

Citations

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Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy
Chun Geun Lim, Hui Joong Lee
Journal of the Korean Society of Radiology.2024; 85(2): 381. CrossRef
Rule out all differential causes before attributing cerebral bleeding to 5-aminolevulinic acid
Josef Finsterer, Sounira Mehri
Child's Nervous System.2023; 39(4): 847. CrossRef
Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers
P. I. Kuznetsova, A. A. Raskurazhev, S. N. Morozova, I. M. Lovchev, M. S. Novruzbekov, M. M. Tanashyan
Russian neurological journal.2023; 28(5): 21. CrossRef

Case report

Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report: Yusuke Tabata, Shuhei Matsui, Masabumi Miyamoto, Koichiro Omori, Yoichiro Tabata, Tokifumi Majima; J Yeungnam Med Sci. 2023;40(2):212-217. Published online September 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00479

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Abstract PDF

We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

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Hip effusion/synovitis influences results after multiple drilling core decompression for bone marrow edema syndrome of hip
Hua-zhang Xiong, Yan-li Peng, Yu-hong Deng, Ying Jin, Ming-hong Tu, Shu-hong Wu
BMC Surgery.2023;[Epub] CrossRef

Resident fellow section: Teaching images

A 40-year-old man with neuropathic pain in the entire left foot: Jae Hwa Bae, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(2):223-224. Published online August 30, 2022; DOI: https://doi.org/10.12701/jyms.2022.00486

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Focused Review article

Ultrasound-guided interventions for controlling the thoracic spine and chest wall pain: a narrative review: Donghwi Park, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):190-199. Published online April 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00192

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Abstract PDF

Ultrasound-guided injection is useful for managing thoracic spine and chest wall pain. With ultrasound, pain physicians perform the injection with real-time viewing of major structures, such as the pleura, vasculature, and nerves. Therefore, the ultrasound-guided injection procedure not only prevents procedure-related adverse events but also increases the accuracy of the procedure. Here, ultrasound-guided interventions that could be applied for thoracic spine and chest wall pain were described. We presented ultrasound-guided thoracic facet joint and costotransverse joint injections and thoracic paravertebral, intercostal nerve, erector spinae plane, and pectoralis and serratus plane blocks. The indication, anatomy, Sonoanatomy, and technique for each procedure were also described. We believe that our article is helpful for clinicians to conduct ultrasound-guided injections for controlling thoracic spine and chest wall pain precisely and safely.

Citations

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The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef

Original article

Clinical impact of spine magnetic resonance imaging as a valuable prognostic tool for patients with multiple myeloma: a retrospective study: Jung Min Lee, Hee Jeong Cho, Joon-Ho Moon, Sang Kyun Sohn, Byunggeon Park, Dong Won Baek; J Yeungnam Med Sci. 2022;39(4):300-308. Published online March 23, 2022; DOI: https://doi.org/10.12701/jyms.2021.01648

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Abstract PDF Supplementary Material

Background
This study investigated the prognostic impact of spine magnetic resonance imaging (MRI) in patients newly diagnosed with multiple myeloma (MM).
Methods
We retrospectively evaluated 214 patients who were newly diagnosed with MM between March 2015 and December 2019. The patients were classified into five different infiltration patterns based on spine MRI as follows: (1) normal appearance, (2) focal, (3) diffuse, (4) combined focal and diffuse infiltration, and (5) “salt-and-pepper.”
Results
Forty patients (18.7%) showed a normal appearance, whereas focal, diffuse, combined focal and diffuse infiltration, and “salt-and-pepper” patterns were identified in 68 (31.8%), 40 (18.7%), 52 (24.3%), and 14 patients (6.5%), respectively. The patients with normal and “salt-and-pepper” patterns were younger than patients with other patterns (median age, 61.6 vs. 66.8 years; p=0.001). Moreover, 63% and 59.3% of patients with normal and “salt-and-pepper” patterns were scored International Staging System (ISS) stage I and revised ISS (R-ISS) stage I, respectively, whereas only 12.5% of patients with other patterns were scored ISS stage I and R-ISS stage I. Patients with normal and “salt-and-pepper” patterns had a better prognosis than those with other patterns, whereas relapse and death rates were significantly higher in patients with focal, diffuse, and combined MRI patterns.
Conclusion
Characteristic MRI findings have a significant prognostic value for long-term survival in patients newly diagnosed with MM. In particular, focal, diffuse, and combined focal and diffuse infiltration patterns are unfavorable prognostic factors.

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Lesions of the spinal cord caused by multiple myeloma: A systematic review and meta-analysis regarding the neurosurgical aspects of patient management
Daniel Encarnacion, Gennady E Chmutin, Ismail Bozkurt, Jack Wellington, Emmanuel Batista Geraldino, Bipin Chaurasia
Journal of Craniovertebral Junction and Spine.2023; 14(4): 313. CrossRef

Case report

Posterior reversible encephalopathy syndrome related to anemia correction in a patient with uterine myoma: a case report: Jisun Lee, Hyun Jung Lee; J Yeungnam Med Sci. 2022;39(4):336-340. Published online September 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.01375

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Abstract PDF Supplementary Material

Although posterior reversible encephalopathy syndrome (PRES) is induced by various causes, a few cases have occurred after severe anemia correction. In this case report, a 45-year-old female patient visited emergency department with a chief complaint of dizziness due to severe anemia related to hypermenorrhea caused by uterine myoma. Before her operation, she had an abrupt headache and seizure during anemia correction with transfusion and injection of gonadotropin-releasing hormone agonist. Immediately after the operation, she experienced visual disturbances, followed by limb weakness and tonic-clonic movements. Magnetic resonance imaging showed alterations in parietal and occipital lobes suggesting cerebrovascular edema with hypoperfusion. Here, we presented and discussed the clinical and radiologic features of PRES related to anemia correction.

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Erum Shariff, Nehad Mahmoud Soltan
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Original article

Clinical performance of FractionLab in patient-specific quality assurance for intensity-modulated radiotherapy: a retrospective study: Se An Oh, Sung Yeop Kim, Jaehyeon Park, Jae Won Park, Ji Woon Yea; J Yeungnam Med Sci. 2022;39(2):108-115. Published online September 9, 2021; DOI: https://doi.org/10.12701/yujm.2021.01123

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Abstract PDF: Background
This study was aimed at comparing and analyzing the results of FractionLab (Varian/Mobius Medical System) with those of portal dosimetry that uses an electronic portal imaging device. Portal dosimetry is extensively used for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT).
Methods
The study includes 29 patients who underwent IMRT on a Novalis-Tx linear accelerator (Varian Medical System and BrainLAB) between June 2019 and March 2021. We analyzed the multileaf collimator (MLC) DynaLog files generated after portal dosimetry to evaluate the same condition using FractionLab. The results of the recently launched FractionLab at various gamma indices (0.1%/0.1 mm–1%/1 mm) are analyzed and compared with those of portal dosimetry (3%/3 mm).
Results
The average gamma passing rates of portal dosimetry (3%/3 mm) and FractionLab are 98.1 (95.5%–100%) and 97.5% (92.3%–99.7%) at 0.6%/0.6 mm, respectively. The results of portal dosimetry (3%/3 mm) are statistically comparable with the QA results of FractionLab (0.6%/0.6 mm–0.9%/0.9 mm).
Conclusion
This paper presents the clinical performance of FractionLab by the comparison of the QA results of FractionLab using portal dosimetry with various gamma indexes when performing patient-specific QA in IMRT treatment. Further, the appropriate gamma index when performing patient-specific QA with FractionLab is provided.

Case reports

Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm: a case report: Nam Kyung Lee, Suk Kim, Seung Baek Hong, So Jeong Lee, Hyung Il Seo; J Yeungnam Med Sci. 2022;39(1):53-57. Published online April 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.00969

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Abstract PDF: Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.

Ultrasonographic and magnetic resonance images of a gluteus maximus tear: Jong Bum Kim, Wonho Lee, Min Cheol Chang; Yeungnam Univ J Med. 2021;38(2):157-159. Published online July 31, 2020; DOI: https://doi.org/10.12701/yujm.2020.00500

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Abstract PDF

The diagnosis of a gluteal muscle tear or strain is based on clinical findings. However, for an accurate diagnosis, imaging examinations are also needed. Herein, we describe the case of a patient with a gluteus maximus muscle tear confirmed by ultrasonography (US) and magnetic resonance imaging (MRI). A 58-year-old woman complained of dull pain in the left lateral gluteal region that she had been experiencing for 8 days. In the axial US image, retraction of the left gluteus maximus muscle was noted around its insertion site in the iliotibial band. On an MRI, a partial tear in the left gluteus maximus was observed at its insertion site in the left iliotibial band. In addition, fluid infiltration due to edema and hemorrhage was observed. A partial left gluteal muscle tear was diagnosed. The patient was treated with physical therapy at the involved region and oral analgesics. She reported relief from the pain after 1 month of treatment. Based on this experience, we recommend US or MRI for accurate diagnosis of muscle tear or strain.

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Review articles

Gallbladder polyps: evolving approach to the diagnosis and management: Kook Hyun Kim; Yeungnam Univ J Med. 2021;38(1):1-9. Published online May 15, 2020; DOI: https://doi.org/10.12701/yujm.2020.00213

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Abstract PDF

Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%–70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.

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Wenqing Bao, Anan Xu, Shubin Ni, Bo Wang, Humaira Urmi, Bin Zhao, Yongmei You, Hai Hu
Scandinavian Journal of Gastroenterology.2021; 56(12): 1450. CrossRef
Polyps and cancer of the biliary system (lecture for medical practitioners)
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Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging: Sung Mee Jung; Yeungnam Univ J Med. 2020;37(3):159-168. Published online April 17, 2020; DOI: https://doi.org/10.12701/yujm.2020.00171

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Abstract PDF

The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infant or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Comparison of airway collapsibility following single induction dose ketamine with propofol versus propofol sedation in children undergoing magnetic resonance imaging: A randomised controlled study
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Indian Journal of Anaesthesia.2024; 68(2): 189. CrossRef
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Jasim M. Salman, Jasim N. Al-Asadi, Husham H. Abdul-Ra’aoof, Jawad H. Ahmed, Ali H Reshak
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Original articles

Usefulness of subtraction pelvic magnetic resonance imaging for detection of ovarian endometriosis: Hyun Jung Lee; Yeungnam Univ J Med. 2020;37(2):90-97. Published online October 10, 2019; DOI: https://doi.org/10.12701/yujm.2019.00353

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Abstract PDF

Background
To minimize damage to the ovarian reserve, it is necessary to evaluate the follicular density in the ovarian tissue surrounding endometrioma on preoperative imaging. The purpose of the present study was to evaluate the usefulness of subtraction pelvic magnetic resonance imaging (MRI) to detect ovarian reserve.
Methods
A subtracted T1-weighted image (subT1WI) was obtained by subtracting unenhanced T1WI from contrast-enhanced T1WI (ceT1WI) with similar parameters in 22 patients with ovarian endometrioma. The signal-to-noise ratio (SNR) in ovarian endometrioma, which was classified into the high signal intensity and iso-to-low signal intensity groups on the T2-weighted image, was compared to that in normal ovarian tissue. To evaluate the effect of contrast enhancement, a standardization map was obtained by dividing subT1WI by ceT1WI.
Results
On visual assessment of 22 patients with ovarian endometrioma, 16 patients showed a high signal intensity, and 6 patients showed an iso-to-low signal intensity on T1WI. Although SNR in endometrioma with a high signal intensity was higher than that with an iso-to-low signal intensity, there was no difference in SNR after the subtraction (13.72±77.55 vs. 63.03±43.90, p=0.126). The area of the affected ovary was smaller than that of the normal ovary (121.10±22.48 vs. 380.51±75.87 mm2, p=0.002), but the mean number of pixels in the viable remaining tissue of the affected ovary was similar to that of the normal ovary (0.53±0.09 vs. 0.47±0.09, p=0.682).
Conclusion
The subtraction technique used with pelvic MRI could reveal the extent of endometrial invasion of the normal ovarian tissue and viable remnant ovarian tissue.

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Carly Pellow, Siyun Li, Sagid Delgado, G Bruce Pike, Laura Curiel, Samuel Pichardo
Physics in Medicine & Biology.2023; 68(19): 195006. CrossRef
Magnetic resonance imaging texture analysis for the evaluation of viable ovarian tissue in patients with ovarian endometriosis: a retrospective case-control study
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Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging: See Hyung Kim; Yeungnam Univ J Med. 2019;36(3):231-240. Published online June 13, 2019; DOI: https://doi.org/10.12701/yujm.2019.00234; Correction in: J Yeungnam Med Sci 2020;37(2):147

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Abstract PDF

Background
We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.
Methods
Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), Ktrans (vessel permeability), and Ve (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.
Results
There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, Ktrans and Ve values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.
Conclusion
Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

Citations

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Erratum to “Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging”
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Review

Can we rejuvenate? Implications of biological aging research: Youlim Son, Jae Ryong Kim; Yeungnam Univ J Med. 2017;34(1):1-10. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.1

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Abstract PDF: The life history of man is summarized as a birth-aging-disease-death. Man eventually ages and dies. How long can humans live? What is aging? Why do we age? Is aging inevitable? Can we rejuvenate? Recent researches on biological aging suggest that humans might overcome aging and rejuvenate. In this paper, we review the biologic characteristics of aging and the latest results of biological aging research, implicating that aging can be controlled, further treated, and that humans can ultimately be rejuvenated.

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