Risk of thyroid cancer in a lung cancer screening population of the National Lung Screening Trial according to the presence of incidental thyroid nodules detected on low-dose chest CT.

PURPOSE: This study evaluated thyroid cancer risk in a lung cancer screening population according to the presence of an incidental thyroid nodule (ITN) detected on low-dose chest computed tomography (LDCT). METHODS: Of 47,837 subjects who underwent LDCT, a lung cancer screening population according to the National Lung Screening Trial results was retrospectively enrolled. The prevalence of ITN on LDCT was calculated, and the ultrasonography (US)/fine-needle aspiration (FNA)-based risk of thyroid cancer according to the presence of ITN on LDCT was compared using the Fisher exact or Student t-test as appropriate. RESULTS: Of the 2,329 subjects (female:male=44:2,285; mean age, 60.9±4.9 years), the prevalence of ITN on LDCT was 4.8% (111/2,329). The incidence of thyroid cancer was 0.8% (18/2,329, papillary thyroid microcarcinomas [PTMCs]) and was higher in the ITN-positive group than in the ITN-negative group (3.6% [4/111] vs. 0.6% [14/2,218], P=0.009). Among the 2,011 subjects who underwent both LDCT and thyroid US, all risks were higher (P<0.001) in the ITNpositive group than in the ITN-negative group: presence of thyroid nodule on US, 94.1% (95/101) vs. 48.6% (928/1,910); recommendation of FNA according to the American Thyroid Association guideline and Korean Thyroid Imaging Reporting and Data System guideline, 41.2% (42/101) vs. 2.4% (46/1,910) and 39.6% (40/101) vs. 1.9% (37/1,910), respectively. CONCLUSION: Despite a higher risk of thyroid cancer in the LDCT ITN-positive group than in the ITN-negative group in a lung cancer screening population, all cancers were PTMCs. A heavy smoking history may not necessitate thorough screening US for thyroid incidentalomas.

Comparison of Core Needle Biopsy and Repeat Fine-Needle Aspiration in Avoiding Diagnostic Surgery for Thyroid Nodules Initially Diagnosed as Atypia/Follicular Lesion of Undetermined Significance.

OBJECTIVE: To compare core needle biopsy (CNB) and repeat fine-needle aspiration (rFNA) to reduce the rate of diagnostic surgery and prevent unnecessary surgery in nodules initially diagnosed as atypia/follicular lesions of undetermined significance (AUS/FLUS). MATERIALS AND METHODS: This study included 231 consecutive patients (150 female and 81 male; mean age ± standard deviation, 51.9 ± 11.7 years) with 235 thyroid nodules (≥ 1 cm) initially diagnosed as AUS/FLUS, who later underwent both rFNA and CNB. The nodules that required diagnostic surgery after the biopsy were defined using three different scenarios according to the rFNA and CNB results: criterion 1, surgery for low-risk indeterminate (categories I and III); criterion 2, surgery for high-risk indeterminate (categories IV and V); and criterion 3, surgery for all indeterminate nodules (categories I, III, IV, and V). We compared the expected rates of diagnostic surgery between CNB and rFNA in all 235 nodules using the three surgical criteria. In addition, the expected rates of unnecessary surgery (i.e., surgery for benign pathology) were compared in a subgroup of 182 nodules with available final diagnoses. RESULTS: CNB showed significantly lower rates of nondiagnostic, AUS/FLUS, and suspicious for malignancy diagnoses (p ≤ 0.016) and higher rates of follicular neoplasm or suspicious for a follicular neoplasm (p < 0.001) and malignant diagnoses (p = 0.031). CNB showed a significantly lower expected rate of diagnostic surgery than rFNA for criterion 1 (29.8% vs. 48.1%, p < 0.001) and criterion 3 (46.4% vs. 55.3%, p = 0.029), and a significantly higher rate for criterion 2 (16.6% vs. 7.2%, p = 0.001). CNB showed a significantly lower expected rate of unnecessary surgery than rFNA for criterion 1 (18.7% vs. 29.7%, p = 0.024). CONCLUSION: CNB was superior to rFNA in reducing the rates of potential diagnostic surgery and unnecessary surgery for nodules initially diagnosed as AUS/FLUS in a scenario where nodules with low-risk indeterminate results (categories I and III) would undergo surgery.

Diabetes is not protective against the formation of unruptured cerebral aneurysm.

OBJECTIVES: Diabetes appears to decrease the risk of subarachnoid hemorrhage. However, it is not clear whether diabetes decreases the risk of aneurysm formation. The aim of our study to evaluate the risk of unruptured cerebral aneurysm in patients with diabetes mellitus. METHODS: We used data from participants who underwent brain magnetic resonance angiography (MRA) and laboratory tests at the Healthcare System Gangnam Center of Seoul National University Hospital between January 2010 and December 2013. From the 17,368 participants who underwent brain MRA, we analyzed 16,337 subjects whose diabetes status could be identified. RESULTS: The number of participants with diabetes was 2299 (14.1%). The proportion of participants with cerebral aneurysms was 2.3% in the diabetic group and 2.7% in the non-diabetic group, which was not significantly different (P = 0.225). There were no significant differences in the size, location, and multiplicity of aneurysms between the diabetes and control groups. In multivariate logistic regression, older age showed significant risk effects on cerebral aneurysms, but female sex, hypertension, diabetes, obesity, and smoking did not show significant risk effects. CONCLUSION: In this study, diabetes did not affect the risk of cerebral aneurysm formation. In addition, neither smoking, nor hypertension was a significant risk factor for unruptured cerebral aneurysms. The lack of association between cerebral aneurysm and the traditional risk factors for subarachnoid hemorrhage requires further study. Risk factors for cerebral aneurysm development and those for cerebral aneurysm rupture may be different.

Distribution and malignancy risk of six categories of the pathology reporting system for thyroid core-needle biopsy in 1,216 consecutive thyroid nodules.

PURPOSE: The purpose of this study was to present the distribution of lesions among the six categories of the pathology reporting system for thyroid core-needle biopsy (CNB), along with the range of malignancy risk of each category based on different diagnostic criteria for benignity in a clinical cohort. METHODS: For 1,216 consecutive nodules (≥1 cm) of 1,125 patients who underwent CNB at two hospitals, the diagnostic results based on the six categories of thyroid CNB were analyzed. Patients were divided into three groups according to prior fine-needle aspiration (FNA) status: second-line CNB for nodules where prior FNA yielded nondiagnostic or unsatisfactory results (n=57), second-line CNB for nodules with prior FNA results of atypia/follicular lesion of undetermined significance (AUS/FLUS) (n=303), and first-line CNB (n=856). RESULTS: The proportion of nodules in each CNB category and the range of the malignancy rate for each category was as follows, in order from category I to VI: 1.8%, 23.1%-75.0%; 57.9%, 0.7%-16.7%; 16.0%, 13.2%-46.7%; 8.8%, 53.8%-56.8%; 2.0%, 100%; and 13.5%, 100%. First-line CNB was associated with a higher rate of conclusive diagnoses (category II, IV, or VI) (725 of 856, 84.7%) than second-line CNB with prior nondiagnostic or AUS/FLUS FNA results (241 of 360, 66.9%; P<0.001). CONCLUSION: The overall distribution of nodules across the six categories of thyroid CNB and the ranges of malignancy risk for those categories were presented in a clinical cohort. First-line CNB tended to produce a higher rate of conclusive results than second-line CNB with prior inconclusive FNA results.

Study of muscle contraction induced by electrical pulse stimulation and nitric oxide in C2C12 myotube cells.

PURPOSE: This study aimed to examine the independent effect of electrical pulse stimulation(EPS) and nitric oxide(NO) on muscle contraction and their synergistic or combined effect on contraction phenomenon using C2C12 mouse skeletal muscle cells. METHODS: Some differentiated C2C12 myotube cells were untreated (control). Other cells did not receive EPS and did receive 0.5, 1.0, or 2.0 mM of the NO donor, S-nitroso-N-acetyl-penicillamine (SNAP; -E/S0.5, -E/S1.0, and -E/S2.0, respectively). For the EPS treatments (0.3 V/mm, 1.0 Hz, and 4.0 ms), differentiated C2C12 myotube cells received only EPS or both EPS and the SNAPtreatments at the same concentrations (+E/-S, +E/S0.5, +E/S1.0, and +E/S2.0, respectively). All samples were then cultured for 4 days. RESULTS: Differentiated C2C12 cellswere stimulated by the EPS, NO, and EPS+NO treatments. The cell length of the +E/S2.0 Group after the 4-day culture (84.2±13.2㎛) was the shortest of all the groups. The expressions of AMPK, JNK, Akt, eNOS, GLUT4, and PGC1α proteins were noticeably dominant. The results indicated synergistic effect on muscle contraction of simultaneously applied EPS and SNAP. CONCLUSION: Motor skills were significantly improved when exercise was accompanied by the intake of NO precursor and/or NO, compared to that upon their independent application or treatment.

Non-obese fatty liver disease is associated with lacunar infarct.

BACKGROUND/AIMS: Lacunar infarct, a small subcortical ischaemic lesion, is a known risk factor for future cognitive impairment, dementia and stroke. We evaluated the relationship between fatty liver disease (FLD) and lacunar infarct in a healthy general population. METHODS: Subjects who underwent brain magnetic resonance imaging (MRI) and abdominal ultrasonography (US) during health check-ups from 2007 to 2009 were included. FLD was diagnosed by US. Subjects with a history of cerebrovascular disease, radiological findings consistent with cerebrovascular stenosis or cerebral small vessel disease were excluded. RESULTS: Of the 1277 subjects, 54 (4.2%) exhibited lacunar infarct, and 514 (40.3%) had FLD. Subjects with lacunar infarct had a higher prevalence of FLD (59.3% vs 39.4%, P = .004). There was significant interaction between obesity (BMI < 25 kg/m2 vs ≥ 25 kg/m2 ) and FLD for lacunar infarct (P for interaction = .024). Subgroup analysis revealed that non-obese FLD was more common in the subjects with lacunar infarct than those without (51.7% vs 23.5%, P = .001). However, there was no significant difference in the obese FLD prevalence between these 2 groups. In multivariate models adjusted by age, sex, smoking, alcohol, hypertension and diabetes, FLD was significantly associated with lacunar infarct (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.08-3.58; P = .027). Non-obese FLD was associated with lacunar infarct (OR 3.58; 95% CI 1.63-7.89; P = .002); however, this association remained insignificant in obese FLD. Instead, ageing and hypertension were independent risk factors for lacunar infarct in the obese population. CONCLUSIONS: FLD is significantly associated with lacunar infarct, independent of traditional risk factors. This association was prominent in the non-obese population.

Effects of voluntary exercise on apoptosis and cortisol after chronic restraint stress in mice.

PURPOSE: To determine whether voluntary exercise (wheel running) has the potential of relieving stress. METHODS: In this study, restraint stress with or without voluntary wheel running was performed for mice housed in individual cages. A total of 21 ICR male mice were assigned into control (CON), restraint stress with voluntary exercise (RSVE), or restraint stress (RS) without voluntary exercise groups (n = 7 each). RESULTS: No significant difference in body weight increase was found among the three groups, although CON and RS groups had a tendency of having smaller body weight increase compared to the RSVE group. No significant difference in the expression level of liver heat shock protein 70, Bcl-2, or p53 was found among the three groups. However, caspase-3 protein level in RS group was significantly higher than that in the other two groups. Blood cortisol concentration in RS was higher (p < 0.05) than that in RSVE or CON group. It was the lowest (p < 0.05) in the RSVE group. CONCLUSION: Our findings suggest that apoptosis caused by chronic restraint stress might be suppressed by voluntary exercise in mice.

Thyroid Imaging Reporting and Data System Risk Stratification of Thyroid Nodules: Categorization Based on Solidity and Echogenicity.

BACKGROUND: Although ultrasonography (US) has an essential role in assessing the malignancy risk of thyroid nodules, a malignancy risk-stratification system has not been established. The purpose of this study was to develop a clinically feasible US risk-stratification system--the Thyroid Imaging Reporting and Data System (TIRADS)--primarily based on the solidity and echogenicity of thyroid nodules. METHODS: From January 2010 to May 2011, a total of consecutive 2000 thyroid nodules (≥ 1 cm) with final diagnoses were enrolled from the database of low and high cancer volume institutions (1000 nodules from each institution). For the development of TIRADS, the type and predictive value of US predictors in the groups categorized by solidity and echogenicity were analyzed, and the US predictors were integrated and categorized according to the malignancy risk. RESULTS: The suspicious US features of microcalcification, taller than wide shape, and spiculated/microlobulated margin were independently predictive of malignancy in the solid or hypoechoic nodule group (p < 0.001, respectively). Meanwhile, only microcalcification was independently predictive of malignancy in the partially cystic nodule group (p = 0.006), and microcalcification and spiculated/microlobulated margin were independently predictive of malignancy in the iso- and hyperechoic nodule group (p = 0.002 and p = 0.015, respectively). Although the presence of any suspicious US features had a high malignancy risk in the group of solid hypoechoic nodules, it had an intermediate malignancy risk in the group of partially cystic or iso- and hyperechoic nodules. The malignancy risk of thyroid nodules was stratified into five TIRADS categories by integrating the type and predictive values of US predictors based on solidity and echogenicity. CONCLUSION: The malignancy risk of thyroid nodules can be stratified by TIRADS according to US patterns by combining solidity, echogenicity, and suspicious US features. The proposed risk-stratification system based on solidity and echogenicity will be useful for risk stratification and management decision of thyroid nodules.

The effect of swimming exercise and powdered-Salicornia herbacea L. ingestion on glucose metabolism in STZ-induced diabetic rats.

PURPOSE: The purpose of this study is to observe the effects of Salicornia herbacea L. powder ingestion on carbohydrate metabolism in STZ-induced diabetic rats. METHODS: To achieve this objective, 35 Sprague-Dawley male rats were raised with feed mixed with Salicornia herbacia L. powder and given specific periods to swim for 5 weeks. There was no significant difference in the insulin increase rate while ingesting Salicornia herbacea L. powder and simultaneously exercising. RESULTS: Compared to the diabetes mellitus group, HOMA-IR was significantly decreased in the diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and the diabetes mellitus + Salicornia herbacea + exercise group. However, changes in blood glucose were significant in each group. Thus, for the result of GLUT-4 and GLUT-2, which are the glycose transporters of the liver and muscle, diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and diabetes mellitus + Salicornia herbacea + exercise group showed significantly higher expressions. The glycogen concentration of the liver and muscle was significantly increased in the diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and diabetes mellitus + Salicornia herbacea + exercise group. CONCLUSION: With the results above, it seems that taking Salicornia herbacea L. powder and exercise will help prevent various diabetic complications. Therefore, the findings of this study could justify Salicornia herbacea L. powder with its basal data of physiological activities and pharmacological components as a type of health functional food.

Decursin from Angelica gigas Nakai Inhibits B16F10 Melanoma Growth Through Induction of Apoptosis.

Decursin, a bioactive phytochemical isolated from Angelica gigas Nakai (danggwi), has shown preclinical anticancer efficacy in various cancer models. However, the antitumor effect of decursin in melanoma models remains undefined. The antitumor activities of decursin were investigated in B16F10 cells in vitro and in vivo. In this study, we show that treatment with decursin inhibited cell proliferation in a dose-dependent manner in B16F10 cells, but not in normal cells. Decursin also induced apoptosis in B16F10 cells, as determined by annexin V-staining assay and transferase-mediated nick-end labeling (TUNEL) staining assay. Decursin increased the phosphorylation of p38 as well as the expression of Bax while decreasing the phosphorylation of extracellular signaling-regulated kinase (ERK) and the expression of Bcl-2 in B16F10 cells. Moreover, decursin activated caspase-3 in B16F10 cells and xenograft tumor tissue. Together, these findings support further investigations into the potential use of decursin in the treatment of melanoma cells.

Persimmon vinegar ripening with the mountain-cultivated ginseng ingestion reduces blood lipids and lowers inflammatory cytokines in obese adolescents.

PURPOSE: This study investigated the effect of the vinegar, which is made of 4-year-old mountain-cultivated ginseng ripened into 4-year-matured persimmon vinegar, on the blood lipids level and inflammatory cytokines concentration in obese female adolescents. METHODS: Subjects ingested the vinegar, so-called 'mountain-cultivated ginseng persimmon vinegar (MPV)', without meals every day for 6 weeks with activities control. Subjects were grouped into control (CON), persimmon vinegar (PV), and MPV with 10 people in each group. Blood lipids, triglyceride (TG), total-cholesterol (TC), and high density lipoprotein-cholesterol (HDL-C) were analyzed. Also, glutamic oxaloacetic transaminase (GOT) and glutamate pyruvate transaminase (GPT) were analyzed for the hepatotoxicity. Blood cytokines, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) were analyzed. RESULTS: Subjects showed a high reduction in body weight and body fat. Their blood lipid level was effectively improved, and the secretion of inflammatory cytokine was suppressed as well, except for TNF-α. However, the change ratio of the cytokines was high in PV and MPV. Such results were similar to those from research subjects who took persimmon vinegar only (PV), but the effect of the vinegar (MPV) was more remarkable. Besides, this mixture was found to have no effect on the hepatotoxicity. CONCLUSION: The significance of this study is that all the experiments were conducted without controlling research subjects' daily lives, and it is suggested that the vinegar may be recommended as a kind of health supplement food to suppress obesity. Especially, since these two products are traditional foods of Korean people, which have been taken for ages, it is expected that the fusing of two foods may be better applied to ordinary people who are concerned about obesity.

Usefulness of core needle biopsy for thyroid nodules with macrocalcifications: comparison with fine-needle aspiration.

BACKGROUND: This study was performed to determine the benefits of core needle biopsy (CNB), as compared with fine-needle aspiration (FNA), for the diagnosis of thyroid nodules with macrocalcifications. MATERIALS AND METHODS: The institutional review board approved this retrospective study, and informed consent was waived. From February 2010 to March 2012, the study included 147 thyroid nodules with macrocalcification of 145 consecutive patients who underwent simultaneous FNA and CNB for each nodule. Diagnostic accuracy and inconclusive diagnoses, including nondiagnostic reading and atypia of undetermined significance or follicular lesion of undetermined significance reading were compared among FNA, CNB, and a combination of FNA and CNB (FNA/CNB) using McNemar's test; the benefits of CNB were calculated. RESULTS: Compared to FNA, CNB and FNA/CNB showed fewer inconclusive diagnoses (FNA vs. CNB: 62/147 [42.2%] vs. 14/147 [9.5%], p<0.001; FNA vs. FNA/CNB: 62/147 [42.2%] vs. 14/147 [9.5%], p<0.001), resulting in the avoidance of repeat FNA or diagnostic surgery in 48 of 62 patients (77.4%, respectively in CNB and FNA/CNB) who would have undergone these procedures if only FNA was performed. Compared to FNA, FNA/CNB showed higher sensitivity and accuracy (sensitivity: 23/32 [71.9%] vs. 31/32 [96.9%], p=0.008; accuracy: 77/86 [89.5%] vs. 85/86 [98.8%], p=0.008), resulting in avoidance of delayed surgery in eight of nine patients (88.9%) with thyroid cancer in whom the surgery would have been missed if FNA only had been performed. CONCLUSION: In the workup of thyroid nodules with macrocalcification, compared with FNA alone, FNA/CNB decreases inconclusive diagnoses and increases sensitivity, thereby reducing repeated FNA procedures, diagnostic surgeries, and delayed therapeutic surgeries.

Ultrasound-Based Risk Stratification for Malignancy in Thyroid Nodules: A Four-Tier Categorization System.

OBJECTIVES: The purpose of this study was to stratify the malignancy risk of US features, with an emphasis on nodule echogenicity. METHODS: A total of 1,058 nodules of 824 consecutive patients (236 malignant and 822 benign) were included in this study. Malignancy risk of each nodule was analyzed according to US features, with an emphasis on nodule echogenecity, and was stratified into 4-tier categories. RESULTS: In multivariate analysis, isoechogenicity, indistinct margin, non-solid internal content, and parallel orientation were predictive of benign nodules (P < 0.002), while hypoechogenicity, marked hypoechogenicity, spiculated/microlobulated margin, solid content, nonparallel orientation (taller than wide), microcalcification, and macrocalcification were predictive of malignancy (P ≤ 0.037). Although the presence of US features associated with malignancy was significantly predictive of malignancy in hypoechoic and markedly hypoechoic nodules (P ≤ 0.004), it was not associated with malignancy in isoechoic or hyperechoic nodules. Thyroid nodules could be stratified into four categories according to the malignancy risk: benign (risk 0%), probably benign (risk ≤ 5%), indeterminate (risk > 5 and < 50%), and suspicion of malignancy (risk > 50%). CONCLUSIONS: The US-based four-tier categorization system will be useful for predicting the risk of malignancy and decisions regarding FNA for thyroid nodules. KEY POINTS: • No US feature was predictive of malignancy in isoechoic nodules. • Isoechoic nodules without calcification can be included in the probably benign category. • We suggest a four-tier categorization stratified primarily by nodule echogenecity. • The four-tier categorization of thyroid nodules will be useful for FNA decisions.

Antioxidant and antiapoptotic effects of pine needle powder ingestion and endurance training in high cholesterol-fed rats.

PURPOSE: Pine needle is a kind of medicinal plant ingested traditionally for a variety of purposes. Therefore, we examined the antioxidant and antiapoptotic capacities of pine needle ingestion in high cholesterol-fed and endurance exercise-trained rats. METHODS: Animals were divided into six groups as; CON: normal diet control group; EX: normal diet and exercise training group; HC: high cholesterol diet group; HCE: high cholesterol diet and exercise training group; HCP: high cholesterol and pine needle group; HCPE: high-cholesterol and pine needle diet with exercise training group, respectively. Each group consisted of seven Sprague-Dawley male rats. The swim-training groups, EX, HCE, and HCPE swam in the swim pool 60 min/d and 5 d/week for 5 weeks. During the rearing periods, freeze-dried pine needle powder mix with 5% of the high cholesterol diet was supplied to the HCP and HCPE groups. Gastrocnemius muscle was used as the skeletal muscle. Malondialdehyde (MDA), Mn-containing superoxide dismutase (Mn-SOD), Cu, Zn containing superoxide dismutase (Cu,Zn-SOD), and glutathione peroxidase (GPx) were analyzed for their antioxidant capacities. Finally, p53, Bcl-2 (B-cell lymphoma 2), caspase-3 protein expression was analyzed to determine antiapoptotic ability. RESULTS: MDA showed low content in HCPE compared to the HC. Mn-SOD, Cu,Zn-SOD, and GPx protein expression was significantly increased by pine needle ingestion and/or exercise training. In addition, suppression of p53 protein expression resulted in Bcl-2 increase followed by caspase-3 decrease with/without pine needle ingestion and exercise training. CONCLUSION: When exercise training in addition to pine needle powder ingestion may be a helpful nutritional regimen to athletes and exercisers.

Arterial stiffness using cardio-ankle vascular index reflects cerebral small vessel disease in healthy young and middle aged subjects.

AIM: The cardio-ankle vascular index (CAVI) reflects overall arterial stiffness from the aorta to the ankle, independent of blood pressure. Cerebral small vessel diseases (SVDs), including white matter lesions (WML), silent lacunar infarction (SLI) and cerebral microbleeds (CMB), are considered to increase the risk of stroke and cognitive impairment further. We aimed to investigate the association of cerebral SVD with CAVI in asymptomatic young and middle-aged subjects. METHODS: Asymptomatic Korean individuals aged 30 to 59 years old without neurologic disease who had CAVI and brain magnetic resonance imaging (MRI) were evaluated retrospectively. RESULTS: Among 484 subjects, cerebral SVDs (advanced WML, SLI and CMB) were found in 20 (4.1%). Subjects with SVDs tended to be older and to have higher systolic blood pressure (SBP) and higher CAVI. From multivariate regression analysis, including pulse pressure (PP) or SBP, CAVI showed a significant association with SVD [adjusted OR (95% CI): 1.889 (1.094-3.263), p= 0.002 and 1.793 (1.020-3.153), p= 0.043, for PP and SBP, respectively]. When CAVI was assessed by quartiles, the highest quartile of CAVI (CAVI >7.65) showed a significant association with SVD, after adjustment for PP [adjusted OR (95% CI): 2.766 (1.115-6.866), p= 0.028]. CONCLUSION: In young and middle-aged subjects, cerebral SVD was significantly associated with arterial stiffness measured by CAVI after adjusting for PP or SBP.

Multi-detector row computed tomographic evaluation of bronchopleural fistula: correlation with clinical, bronchoscopic, and surgical findings.

OBJECTIVES: To evaluate the usefulness of multi-detector row computed tomography (CT) in the diagnosis of bronchopleural fistula (BPF) and to correlate CT features with clinical, bronchoscopic, and surgical findings. METHODS: Twenty-four patients had a final diagnosis of BPF. Thin-section axial and coronal multiplanar reformation images from multi-detector row CT datasets were assessed by 2 radiologists in consensus. The CT direct sign of BPF was a fistulous tract between the bronchus or lung and pleural space. The indirect signs were air bubbles beneath the bronchial stump or suspected fistula. RESULTS: Computed tomography demonstrated fistulous tract (central type, 3; peripheral type, 11) or indirect signs of BPF (central type, 3; peripheral type, 6), whereas bronchoscopy demonstrated 2 fistula openings (all central type) and indirect signs of BPF (central type, 2; peripheral type, 1). CONCLUSIONS: Thin-section axial and multiplanar reformation images are helpful in the diagnosis of BPF. Multi-detector row CT can be an initial diagnostic modality of BPF.

Diagnosis of acute appendicitis with sliding slab ray-sum interpretation of low-dose unenhanced CT and standard-dose i.v. contrast-enhanced CT scans.

OBJECTIVE: The purpose of this study was to compare low-dose unenhanced CT with standard-dose i.v. contrast-enhanced CT in the diagnosis of appendicitis. MATERIALS AND METHODS: Two hundred seven adults with suspected appendicitis underwent CT with mean effective doses of both 4.2 and 8.0 mSv. Two radiologists retrospectively reviewed thin-section images by sliding a 5-mm-thick ray-sum slab. They rated the likelihood of appendicitis and appendiceal visualization on 5- and 3-point scales, respectively, and proposed alternative diagnoses. Likelihood > or = 3 was considered a positive diagnosis. Receiver operating characteristics analysis, the McNemar test, and the Wilcoxon's signed-rank test were used. RESULTS: Seventy-eight patients had appendicitis. The values of the area under the receiver operating characteristics curve were 0.98 for the low-dose unenhanced acquisition and 0.97 for the standard-dose contrast-enhanced acquisition for reader 1 (95% CI for the difference, -0.02 to 0.03) and 0.99 and 0.98 (-0.02 to 0.02) for reader 2. Sensitivity was 98.7% for low-dose unenhanced CT and 100% for standard-dose contrast-enhanced CT for reader 1 (p = 1.00) and 100% for both techniques for reader 2. Specificity was 95.3% and 93.0% (p = 0.25) and 96.9% and 96.9%. The interpretation was indeterminate (score 3) in 0.5% and 1.4% of cases for reader 1 (p = 0.63) and 0.5% and 0% for reader 2 (p = 1.00). A normal appendix was not visualized in 5.4% and 3.9% of cases by reader 1 (p = 0.63) and 3.9% and 2.3% of cases by reader 2 (p = 0.50). None of the patients whose appendix was not visualized had appendicitis. Diagnostic confidence, visualization score for a normal appendix, and correct alternative diagnosis tended to be compromised with use of low-dose unenhanced CT, showing a significant difference for a reader's confidence in the diagnosis of appendicitis (p = 0.004). The two techniques were comparable in the diagnosis of appendiceal perforation. CONCLUSION: Low-dose unenhanced CT is potentially useful in the diagnosis of appendicitis.

Evaluation of the gross type and longitudinal extent of extrahepatic cholangiocarcinomas on contrast-enhanced multidetector row computed tomography.

OBJECTIVE: The objective of this study was to determine the accuracy of contrast-enhanced multidetector row computed tomography (MDCT) in classifying the morphological subtype and revealing the longitudinal extent of extrahepatic cholangiocarcinomas (EHCs). METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Two radiologists reviewed the preoperative MDCT images of 56 patients who had undergone surgical treatment of EHCs from 2000 to 2006. The reviewers classified the morphological subtypes and measured the enhancing segment of the bile duct with wall thickening on axial images; they then reviewed the axial and multiplanar reconstruction images of 39 patients. The image analysis results were compared with the pathological findings. RESULTS: The accuracy of MDCT for morphological classification was 78.6% (44/56). The differences between the radiological and pathological measurements of the longitudinal extent of the tumors ranged from 0 to 53.5 mm, with a mean (SD) of 5.89 mm (11.42 mm). There was moderate correlation between the 2 measurements of the longitudinal extent of the tumors (P < 0.05, gamma = 0.4455). In 35 patients, MDCT measurements did not differ significantly from the pathological measurements (62.5%). In 18 patients, computed tomography (CT) underestimated the longitudinal extent of the tumor by more than 6 mm (32.1%). In the 39 patients with multiplanar reconstruction images, the correlation between the CT and the pathological measurements of the longitudinal extent was better in the combined interpretation of the axial and coronal images (P < 0.05, gamma = 0.4153) than that in the interpretation of only the axial images (P > 0.05, gamma = 0.2652). CONCLUSIONS: Our results demonstrate that MDCT can correctly classify the morphological subtype of EHC. Nevertheless, CT has a strong tendency to underestimate the longitudinal tumor extent compared with the pathological results.

Central venous infusion port inserted via high versus low jugular venous approaches: retrospective comparison of outcome and complications.

PURPOSE: To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches. MATERIALS AND METHODS: The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n=7), operation scar (n=6), radiation scar (n=5), failure of low jugular vein puncture (n=2), and abnormal course of right subclavian artery (n=1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port. RESULTS: The procedure-related complications were all minor (n=14, 8.6%) in both groups; hematoma (n=4, 2.8% in low jugular puncture group and n=1, 4.8% in high jugular puncture group, p=0.6295), air embolism (n=2, 1.4% in low jugular puncture group and n=0 in high jugular puncture group, p=0.5842) and minor bleeding (n=5, 3.5% in low jugular vein puncture group and n=2, 9.5% in high jugular vein puncture group, p=0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p=0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p=0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p=0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p=0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p=0.4232). CONCLUSIONS: Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.