Integration of National Health Insurance claims data and animal models reveals fexofenadine as a promising repurposed drug for Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a common and costly progressive neurodegenerative disease of unclear etiology. A disease-modifying approach that can directly stop or slow its progression remains a major unmet need in the treatment of PD. A clinical pharmacology-based drug repositioning strategy is a useful approach for identifying new drugs for PD. METHODS: We analyzed claims data obtained from the National Health Insurance Service (NHIS), which covers a significant portion of the South Korean population, to investigate the association between antihistamines, a class of drugs commonly used to treat allergic symptoms by blocking H1 receptor, and PD in a real-world setting. Additionally, we validated this model using various animal models of PD such as the 6-hydroxydopmaine (6-OHDA), α-synuclein preformed fibrils (PFF) injection, and Caenorhabditis elegans (C. elegans) models. Finally, whole transcriptome data and Ingenuity Pathway Analysis (IPA) were used to elucidate drug mechanism pathways. RESULTS: We identified fexofenadine as the most promising candidate using National Health Insurance claims data in the real world. In several animal models, including the 6-OHDA, PFF injection, and C. elegans models, fexofenadine ameliorated PD-related pathologies. RNA-seq analysis and the subsequent experiments suggested that fexofenadine is effective in PD via inhibition of peripheral immune cell infiltration into the brain. CONCLUSION: Fexofenadine shows promise for the treatment of PD, identified through clinical data and validated in diverse animal models. This combined clinical and preclinical approach offers valuable insights for developing novel PD therapeutics.

A Large Pleomorphic Adenoma in Nasal Cavity Misdiagnosed as Inverted Papilloma.

Pleomorphic adenoma (PA) is a benign tumor characterized by slow-growing mixed tumors in the craniofacial area. It is relatively common in salivary glands; however, PA of the nasal cavity, which arises in the minor salivary glands, is rare. We present the case of a large PA in the nasal cavity of an adult immunocompetent woman with nasal obstruction and intermittent epistaxis. Based on preoperative radiologic examinations, she was misdiagnosed with an inverted papilloma. Endoscopic resection was performed under general anesthesia. Pathologically, the patient was confirmed to have PA, which has great cellularity and few stromal components. No complications or recurrences during the 1-year follow-up period were observed.

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis.

OBJECTIVE: This study aimed to compare computed tomography (CT) findings between patients with severe and nonsevere acute alcoholic hepatitis (AAH). METHODS: We included 96 patients diagnosed with AAH between January 2011 and October 2021 who underwent 4-phase liver CT and laboratory blood tests. Two radiologists reviewed the initial CT images with respect to distribution and grade of hepatic steatosis; transient parenchymal arterial enhancement (TPAE); and presence of cirrhosis, ascites, and hepatosplenomegaly. A Maddrey discriminant function score (4.6 × [patient's prothrombin time - control] + total bilirubin [mg/mL]) was used as cutoff indicator for severity, with a score of 32 or higher indicating severe disease. The image findings were compared between the severe (n = 24) and nonsevere (n = 72) groups using the χ 2 test or Fisher exact test. After univariate analysis, the most significant factor was identified using a logistic regression analysis. RESULTS: In the univariate analysis, there were significant between-group differences in the TPAE, liver cirrhosis, splenomegaly, and ascites ( P < 0.0001, P < 0.0001, P = 0.0002, and P = 0.0163, respectively). Among them, TPAE was the only significant factor for severe AAH ( P < 0.0001; odds ratio, 48.1; 95% confidence interval, 8.3-280.6). Using this single indicator, the estimated accuracy, positive predictive, and negative predictive values were 86%, 67%, and 97%, respectively. CONCLUSIONS: Transient parenchymal arterial enhancement was the only significant CT finding in severe AAH.

Impact of bevacizumab and secondary cytoreductive surgery on survival outcomes in platinum-sensitive relapsed ovarian clear cell carcinoma: A multicenter study in Korea.

OBJECTIVE: This study investigated survival outcomes for platinum-sensitive relapsed ovarian clear cell carcinoma (OCCC) by treatment method. METHODS: OCCC patients with platinum-sensitive recurrence that received secondary treatment at five institutions between July 2007 and June 2021 were included. Patient characteristics and survival outcomes were compared according to the use of bevacizumab (BEV) during second-line chemotherapy and secondary cytoreductive surgery (CRS). RESULTS: 138 patients were included. The BEV (n = 36) and non-BEV (n = 102) groups had similar initial FIGO stages and proportions of secondary CRS. The BEV group showed improved progression-free survival (PFS; median, 15.4 vs. 7.5 months; P = 0.042) and overall survival (OS; P = 0.043) compared to the non-BEV group. In multivariate analyses, BEV was identified as an independent prognostic factor for PFS (adjusted hazard ratio [aHR], 0.571; 95% confidence interval [CI], 0.354-0.921; P = 0.022) and OS (aHR, 0.435; 95%CI, 0.195-0.970; P = 0.042). The secondary CRS group (n = 42) had early-stage disease at diagnosis more frequently (P = 0.009) and multi-site metastasis (P < 0.001) at recurrence less frequently than the no surgery group (n = 96). The secondary CRS group showed significantly better PFS (median, 33.7 vs. 7.2 months; P < 0.001) and OS (P < 0.001). Secondary CRS was associated with a significantly improved PFS (aHR, 0.297; 95% CI, 0.183-0.481; P < 0.001) and OS (aHR, 0.276; 95% CI, 0.133-0.576; P = 0.001). The BEV and non-BEV groups showed similar PFS and OS among the patients who underwent secondary CRS. In contrast, the BEV group showed improved PFS and OS among patients who did not undergo surgery. CONCLUSIONS: The use of BEV during second-line chemotherapy and secondary CRS may improve PFS and OS in patients with platinum-sensitive relapsed OCCC. Further prospective studies are warranted.

High-Resolution Diffusion-Weighted Imaging for Evaluation of Extramural Tumor Invasion in Primary Rectal Cancer.

OBJECTIVE: The aim of this study was to determine the added value of high-resolution diffusion-weighted imaging (DWI) to T2-weighted imaging (T2WI) for evaluation of extramural tumor invasion (EMTI) in patients with primary rectal cancer. METHODS: Seventy-eight patients who had undergone 3.0-T magnetic resonance imaging including DWI (b = 0, 1000 s/mm2, 2 mm iso-voxel) and subsequent surgery were included. Two blinded radiologists independently read the T2WI first and then the combined DWI set. They recorded their confidence level using a 5-point scale. The diagnostic accuracy was calculated by receiver operating characteristic curve analysis based on the histopathological results as the reference. RESULTS: The study population consisted of EMTI positive (n = 44) and negative (n = 34). The area under the curve was not significantly increased after adding DWI to T2WI (reader 1, 0.868-0.856, P = 0.5618; reader 2, 0.848-0.865, P = 0.4539). CONCLUSION: Adding DWI to T2WI showed no additional diagnostic value for the evaluation of EMTI in patients with primary rectal cancer.

Intraobserver and interobserver reliability in sonographic size measurements of gallbladder polyps.

OBJECTIVES: To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability. METHODS: From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests. RESULTS: The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939-0.973) for observer 1 and 0.962 (95% CI, 0.943-0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926-0.979) for the first measurement and 0.973 (95% CI, 0.950-0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3-25.2% of the mean, and those between the two observers were 25.5-34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps (< 5 mm). There were no significant differences in the ICCs between image settings and polyp location. CONCLUSIONS: Polyp size measurements using transabdominal US are highly repeatable and reproducible. Polyp size significantly affects the reliability of measurement. Diameter changes of approximately less than 25% may fall within the measurement error; this should be considered while interpreting the change in size during follow-up US, especially for small polyps. KEY POINTS: • Gallbladder polyp size measurement using transabdominal US is highly repeatable and reproducible. • Diameter changes of approximately less than 25% should be interpreted carefully, especially in small polyps.

Microwave hydrothermal synthesis and upconversion properties of BiVO4 nanoparticles.

Nanomaterials are the subject of extensive investigations due to their applications in medicine, multimodal imaging, volumetric displays, and photonics. Here, lanthanide-doped bismuth vanadate (BiVO4) upconverting nanoparticles (UCNPs) have been reported. The nanoparticles have been synthesized by a microwave hydrothermal method. As-synthesized nanoparticles are highly crystalline in the tetragonal zircon phase with particles about 200 nm in size. Under 980 nm excitation, intense multicolor visible and near-infrared upconversion emissions are observed. Moreover, broadband infrared downshifting emissions are also observed. Time-resolved emission measurements have been carried out to investigate the involved upconversion and energy transfer mechanism. The BiVO4-based UCNPs may provide a new class of nanomaterials for multifunctional applications.

Correction to: Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting.

The article Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, written by [§§§ AuthorNames §§§].

Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting.

OBJECTIVES: To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. METHODS: Fourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as 'appropriate' or 'inappropriate' (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). RESULTS: Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template. CONCLUSIONS: These updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. KEY POINTS: • These guidelines present recommendations for staging and reporting of rectal cancer. • The guidelines were constructed through consensus amongst 14 pelvic imaging experts. • Consensus was reached by the experts for 92 % of the 246 items discussed. • Practical guidelines for nodal staging are proposed. • A structured reporting template is presented.

Diagnostic performance of advanced modeled iterative reconstruction applied images for detecting urinary stones on submillisievert low-dose computed tomography.

Background Repeated computed tomography (CT) scans may be an issue in young adults with urinary stones. Therefore, it is important to know how far the dose can be reduced while maintaining the diagnostic performance. Purpose To generate a hypothesis that it is feasible to decrease the radiation dose to a sub-millisievert (mSv) level with the addition of advanced modeled iterative reconstruction (ADMIRE) while maintaining the sensitivity to standard-dose CT (SDCT) for the detection of urinary stones. Material and Methods Ninety-two consecutive patients with urinary stones underwent non-enhanced CT that consisted of standard (120 kVp, 200 mAs) and lose-dose (LDCT) (80 kVp, 60 mAs). The LDCT images were reconstructed separately with five different strengths of ADMIRE (hereafter, S1-S5) and filtered back projection (FBP). Two blinded radiologists independently recorded a number of urinary stones in the six LDCT datasets and SDCT. The sensitivity of each set for detecting urinary stones was compared using the McNemar test. Results A total of 240 urinary stones were analyzed. The sensitivities of the six LDCT datasets showed no difference (FBP, S1-S5, for reader 1: 78%, 79%, 79%, 80%, 80%, and 80%; for reader 2: 64%, 63%, 64%, 64%, 65%, and 66%, P > 0.05, respectively), which were lower than those of SDCT for both readers (reader 1: 88%; reader 2: 81%, P < 0.0001, respectively). Conclusion Despite the addition of ADMIRE, it may not be feasible to decrease the radiation dose to a sub-mSv level while maintaining the sensitivity to SDCT for the detection of urinary stones.

Comparison of Model-Based Iterative Reconstruction, Adaptive Statistical Iterative Reconstruction, and Filtered Back Projection for Detecting Hepatic Metastases on Submillisievert Low-Dose Computed Tomography.

OBJECTIVE: The aim of the study was to compare the diagnostic performance of model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASIR), and filtered back projection (FBP) on submillisievert low-dose computed tomography (LDCT) for detecting hepatic metastases. METHODS: Thirty-eight patients having hepatic metastases underwent abdomen CT. Computed tomography protocol consisted of routine standard-dose portal venous phase scan (120 kVp) and 90-second delayed low-dose scan (80 kVp). The LDCT images were reconstructed with FBP, ASIR, and MBIR, respectively. Two readers recorded the number of hepatic metastases on each image set. RESULTS: A total of 105 metastatic lesions were analyzed. For reader 1, sensitivity for detecting metastases was stationary between FBP (49%) and ASIR (52%, P = 0.0697); however, sensitivity increased in MBIR (66%, P = 0.0035). For reader 2, it was stationary for all the following sets: FBP (65%), ASIR (68%), and MBIR (67%, P > 0.05). CONCLUSIONS: The MBIR and ASIR showed a limited sensitivity for detecting hepatic metastases in submillisievert LDCT.

Diffusion-weighted imaging for evaluating lymph node eradication after neoadjuvant chemoradiation therapy in locally advanced rectal cancer.

BACKGROUND: As lymph node (LN) eradication is the prerequisite for clinical surveillance or local excision for patients who have achieved a complete response after preoperative chemoradiation therapy (CRT), the radiological evaluation of LN eradication is important. PURPOSE: To evaluate the added value of diffusion-weighted imaging (DWI) in the evaluation of LN eradication after CRT in patients with locally advanced rectal cancer (LARC). MATERIAL AND METHODS: Ninety-five consecutive patients (64 men, 31 women; mean age, 59 years; range, 32-82 years) who underwent pre- and post-CRT 1.5-T MRI with DWI (b = 0, 1000 s/mm(2)) were enrolled. To evaluate the added value of DWI in the evaluation of LN eradication after CRT, two radiologists first independently read the pre- and post-CRT T2-weighted (T2W) images and then read the combined T2W imaging set and the pre- and post-CRT DWIs with a 4-week interval. The radiologists recorded their confidence scores for LN eradication using a 5-point scale on a per-patient basis. The diagnostic performances were compared between the two reading sessions for each reader with pair-wise comparisons of receiver-operating characteristic curves. Histopathological reports served as the reference standards for LN eradication. RESULTS: The study population consisted of an LN-eradicated group (n = 66) and a non-eradicated group (n = 29). The diagnostic performances did not significantly differ between the two reading sessions for the two readers (AUCs for reader 1, 0.770 and 0.774, P = 0.8155; for reader 2, 0.794 and 0.798, P = 0.8588). CONCLUSION: Adding DWI to T2W imaging provided no additional diagnostic benefit for the evaluation of LN eradication following CRT in patients with LARC.

Clinical results of endoscopic sciatic nerve decompression for deep gluteal syndrome: mean 2-year follow-up.

BACKGROUND: The purpose of this study is to assess the effectiveness of endoscopic sciatic nerve decompression and evaluated the differences of clinical results between atraumatic and traumatic groups. METHODS: Sixty consecutive patients. We retrospectively reviewed sixty consecutive patients without major trauma (45 hips) or with major trauma (15 hips) groups to compare the outcomes of endoscopic treatment.). The mean follow-up period was 24 ± 2.6 months (range, 24-38.4 months). RESULTS: The mean duration of symptoms was 14.1 months (range, 12 to 32 months). Compromising structures were piriformis muscle, fibrovascular bundles, and adhesion with scar tissues. The mean VAS score for pain decreased from 7.4 ± 1.5 to 2.6 ± 1.5 (P = .001). The mean mHHS increased from 81.7 ± 9.6 to 91.8 ± 7.6 (P = .003). Clinically, positive paresthesia and seated piriformis test were statistically significant to diagnosis sciatic entrapment syndrome. Paresthesia and sitting pain were significantly improved at the final follow-up (P = .002). More favorable outcome was observed a group without major trauma. No complication was observed. CONCLUSIONS: Endoscopic sciatic nerve decompression is a safe and effective procedure for the management of DGS. Patients with major trauma could have poor clinical outcome. Seated piriformis test, FADIR, and tenderness of sciatic notch are maybe useful guide for pre and postoperative evaluation of DGS.

Factors Correlating Outcome in Young Infants With Congenital Muscular Torticollis.

PURPOSE: No previous study using follow-up ultrasonography for evaluating the factors associated with the successful regression of congenital muscular torticollis in young infants has been published. This study aimed to assess clinical factors and sonographic features potentially influencing regression in patients with congenital muscular torticollis. METHODS: From January 2010 to December 2012, 80 infants underwent neck ultrasonography because of clinical suspicion of congenital muscular torticollis. We statistically analysed the correlation between complete resolution and clinicosonographic findings when complete resolution was defined as no visible lesion on follow-up ultrasonography. RESULTS: Of the 80 infants, 61 had congenital muscular torticollis and all were followed up by ultrasonography: 1) 34 underwent physiotherapy, and 27 of them (79.4%) revealed complete resolution in follow-up; 2) 27 did not undergo physiotherapy, and 15 of them (55.6%) showed complete resolution. A statistically significant correlation was found between physiotherapy and complete resolution, but not between complete resolution and patient sex; size, volume, and echogenicity of the lesion; and thickness ratio. CONCLUSIONS: Physiotherapy was the only factor influencing complete resolution in young infants with congenital muscular torticollis.

Apparent diffusion coefficient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer.

BACKGROUND: Because further treatment plans depends on lymph node (LN) status after neoadjuvant chemoradiation therapy (CRT), the accurate characterization of LN is important. PURPOSE: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for LN characterization after CRT and to compare the performance with that of LN size. MATERIAL AND METHODS: Fifty-three patients (36 men, 17 women; mean age, 58 years; age range, 34-79 years) who underwent CRT and subsequent surgery were included. All patients underwent 1.5-T magnetic resonance imaging (MRI). Each regional LN on post-CRT MRI was identified in consensus by two radiologists after reviewing the pre-CRT MRI. The ADC value and size in each LN was measured. To compare the mean ADC values and sizes of the metastatic and non-metastatic LNs after CRT, the t-test was used. To calculate the performance, a ROC curve analysis was performed. The histopathological examinations served as the reference standard. RESULTS: A total of 115 LNs (29 metastatic and 86 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly higher than that of the non-metastatic LNs (1.36 ± 0.27 × 10(-3)mm(2)/s; 1.13 ± 0.23 × 10(-3)mm(2)/s, P < 0.0001). The mean size of the metastatic LNs was also significantly larger than that of the non-metastatic LNs (5.6 ± 3.1; 3.9 ± 1.2, P = 0.0078). There was no significant difference between the areas under the curve of the ADC and size (0.742 [95% CI, 0.652-0.819]; 0.680 [0.586-0.764], respectively, P = 0.4090). CONCLUSION: The performance of ADC for LN characterization after CRT was comparable to that of LN size.

Low-dose CT for patients with clinically suspected acute appendicitis: optimal strength of sinogram affirmed iterative reconstruction for image quality and diagnostic performance.

BACKGROUND: As there is increased concern over the radiation exposure particularly in adolescents and young adults, computed tomography (CT) dose reduction is needed in the diagnosis of acute appendicitis. PURPOSE: To evaluate the optimal strength of sinogram affirmed iterative reconstruction (SAFIRE) to obtain the best image quality on a 30-mAs applied low-dose CT (LDCT 30mAs) and to compare the diagnostic performances of the LDCT 30mAs with different SAFIRE strengths with that of the 100-mAs applied LDCT (LDCT 100mAs) for the diagnosis of acute appendicitis. MATERIAL AND METHODS: A total of 102 consecutive patients (47 men, 55 women; mean age, 41.2 years; range, 15-82 years) with right lower quadrant pain underwent abdominal-pelvic CT, consisting of arterial phase LDCT 100mAs and portal venous phase LDCT30mAs under a fixed 120 kV. LDCT 30mAs images were reconstructed separately with five strength levels (S1-S5). Two blinded radiologists recorded scores for the subjective image quality of the LDCT 30mAs dataset (S0-S5) and confidence scores for the diagnosis of acute appendicitis on each dataset and LDCT 100mAs. CT image noise was measured for each set. RESULTS: The study population consisted of 58 patients with confirmed appendicitis and 44 without appendicitis. There was no significant difference in diagnostic performance between LDCT 100mAs and LDCT 30mAs with any strength for both readers (AUC for reader 1, LDCT 30mAs with S0-S5 = 0.97, LDCT 100mAs = 0.93, P = 0.0936; for reader 2, LDCT 30mAs with S0-S5 = 0.96, LDCT 100mAs = 0.97, P = 0.128). The measured noise decreased as the strength increased from S0 to S5 (mean, 20.8 > 17.7 > 15.6 > 13.5 > 11.5 > 9.5, P < 0.0001). However, overall subjective image quality on S3 was better than the other strengths for both readers (S0 < S1 < S2 < S3 > S4 > S5, P < 0.0001). CONCLUSION: Although measured noise declined as SAFIRE strength increased, S3 seems optimal for the best subjective image quality on LDCT 30mAs. The diagnostic performance of LDCT 30mAs with any strength is comparable to that of LDCT 100mAs for the diagnosis of acute appendicitis.

Gray-scale and color Doppler sonographic features of complex fibroadenomas of the breast.

PURPOSE: To investigate gray-scale and color Doppler sonographic (US) features of complex fibroadenoma (FA), according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. METHODS: From 2010 through 2013, 586 women with FAs were seen; 101 (17%) of those lesions were diagnosed as complex FAs on percutaneous needle biopsy or surgery. Among the patients with complex FAs, 67 who had US examination results available were included in this study. In addition, the results from 98 women who had simple FAs were included as controls. US features were retrospectively analyzed by two breast radiologists in consensus for shape, margin, echogenicity, posterior acoustic pattern, boundary, orientation, and associated findings. They also reassessed the BI-RADS category for FAs. Color Doppler US examination results were classified according to the amount of vascularity as absent, moderate, or marked. RESULTS: Complex FA were larger than simple FAs were (14.5 cm versus 12.1 cm, p > 0.05). On univariate analysis, a round to irregular shape, an uncircumscribed margin, the presence of associated findings, and BI-RADS categorization as 4a and 4b were more frequently revealed in complex than in simple FAs (p < 0.05). Multivariate analysis revealed that the tumor margin was a predictive factor for complex FA (odds ratio: 6.08; 95% confidence interval: 1.14-32.49, p < 0.05). On color Doppler US, the complex FAs had higher degrees of vascularity than simple FA (p < 0.05). CONCLUSIONS: Complex FAs, in comparison with simple FAs, tend to have more aggressive features and to be in higher BI-RADS categories on US examination.

Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer.

PURPOSE: To evaluate the usefulness of perfusion parameters derived from dynamic contrast-enhanced MR imaging (DCE-MRI) for assessing the therapeutic response to neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer (LARC). MATERIALS AND METHODS: Fifty patients with LARC (≥T3 or lymph-node metastasis) who underwent CRT and subsequent surgery, were included in this study. All patients underwent pre- and post-CRT DCE-MRI on a 1.5 Tesla unit. By using a postprocessing software, the following perfusion parameters (K(trans) , kep , ve ) were measured for tumor. Those perfusion parameters were compared not only between the T-downstaged group and the nondownstaged group, but also before and after CRT in each group. RESULTS: After CRT, the mean K(trans) (min(-1) ) significantly decreased from 1.24 ± 0.53 to 0.76 ± 0.45 in the T-downstaged group (n = 24) (P = 0.0007), whereas it did not significantly decrease in the nondownstaged group (n = 26) (from 1.02 ± 0.53 to 0.87 ± 0.48, P = 0.24). The percentage difference between pre- and post-CRT K(trans) in the T-downstaged group was significantly higher than that in the nondownstaged group (43%, 16%, respectively, P = 0.0092). However, none of the other parameters showed significant differences. CONCLUSION: A large decrease in the mean K(trans) after CRT was associated with a good therapeutic response to CRT for LARC.

Prognostic stratification by extramural depth of tumor invasion of primary rectal cancer based on the Radiological Society of North America proposal.

OBJECTIVE: The purpose of this study was to investigate the diagnostic performance of MRI in stratifying tumors stage III (T3) in patients with rectal cancer by measuring the extramural depth of tumor invasion based on the Radiologic Society of North America (RSNA) proposal and to validate its role as a prognostic indicator. MATERIALS AND METHODS: From January 2006 to July 2009, 146 patients with surgically and pathologically confirmed T3 rectal adenocarcinoma who underwent preoperative MRI were enrolled. Two blinded radiologists measured the maximum extramural depth of tumor invasion on T2-weighted images. To evaluate the diagnostic performance of MRI for stratifying subgroups, the study population was assigned into three subgroups (T3a, T3b, and T3c) according to extramural depth of tumor invasion (< 5, 5-10, and > 10 mm).To validate the role of extramural depth of tumor invasion as a prognostic indicator, Cox regression analysis was used for estimation of independent risk factors for postoperative recurrence. Three-year recurrence-free survival was evaluated by the Kaplan-Meier method with a log-rank test. Histopathologic reports were used as the reference standard. RESULTS: The overall accuracy of MRI for stratifying subgroups was 71.2% (104/146) and 77.4% (113/146) for reviewers 1 and 2. Extramural depth of tumor invasion was an independent risk factor for 3-year recurrence-free survival (hazard ratio, 2.186; 95% CI, 1.336-3.577; p = 0.002). Kaplan-Meier curves revealed a significant difference in 3-year recurrence-free survival rates for each subgroup (86%, 69%, and 43% for T3a, T3b, and T3c; p < 0.03). CONCLUSION: MRI can be used for prognostic stratification according to extramural depth of tumor invasion based on the RSNA proposal for patients with T3 rectal cancer.

Postoperative low-dose follow-up computed tomography for patients with stomach cancer: optimal blending ratio of adaptive statistical iterative reconstruction for image quality and diagnostic performance.

OBJECTIVE: To compare the diagnostic performance of adaptive statistical iterative reconstruction applied low-dose computed tomography (CT) (LDCT) with that of the standard-dose CT (SDCT) for local recurrence in patients with stomach cancer. METHODS: Seventy-nine consecutive patients who had undergone surgical resection for stomach cancer were enrolled. To monitor recurrence, SDCT (120 kilovolt peak [kVp], 200mAs) had been performed. The LDCT (120 kVp, 100 mA s) was taken, and images were reconstructed with 4 levels of adaptive statistical iterative reconstruction (ASIR) blending (0%, 30%, 50%, and 70%). Two blinded radiologists recorded the diagnostic confidence scores for local recurrence in each data set using a 5-point scale. Endoscopic biopsy results served as the reference standard. Receiver operating characteristic (ROC) curve analysis was used to calculate the diagnostic performance. RESULTS: The diagnostic performance of LDCT with variable ASIR blending ratios was comparable to that of SDCT (area under ROC curve, 0.727-0.734, 0.687, respectively, P > 0.05). CONCLUSIONS: The diagnostic performance of ASIR applied LDCT is comparable to that of SDCT.