The effect of postoperative vaginal progesterone in ultrasound-indicated cerclage to prevent preterm birth.

OBJECTIVES: To compare pregnancy outcomes according to the use of postoperative vaginal progesterone in patients who underwent ultrasound-indicated cerclage. METHODS: This was a retrospective cohort study of 86 consecutive asymptomatic singleton pregnancies who had undergone cerclage because of incidentally found short cervical length under 20 mm through transvaginal ultrasound between 16°/7 and 246/7 weeks' gestational age. Outcomes were compared according to the use of vaginal progesterone after cerclage. Primary outcome measure was preterm delivery < 34 weeks of gestation. RESULTS: (1) The frequency of preterm delivery < 34 weeks of gestation was significantly lower in patients with postoperative vaginal progesterone than those without (2.2 versus 18.4%, p = .021); (2) the median gestational age at delivery in the postoperative vaginal progesterone group was significantly longer than the control group (38.3 weeks (interquartile range, 37.5-39.1 weeks) versus 37.3 weeks (interquartile range 33.9-38.6 weeks), p = .020); (3) Multivariable logistic regression analysis demonstrated the use of vaginal progesterone after cerclage was found to be independently associated with decrease in preterm delivery before 34 weeks (Odds ratio 0.10; 95% confidence interval, 0.01-0.93) and 37 weeks (Odds ratio 0.24; 95% confidence interval, 0.07-0.85). CONCLUSIONS: The use of vaginal progesterone was associated with lower rates of preterm birth before 34 and 37 weeks of gestation in women who underwent ultrasound-indicated cerclage placement.

Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures.

OBJECTIVE: To assess the diagnostic performance of dual-energy computed tomography (DECT) with the color-coded virtual non-calcium (VNC) technique for detecting acute fractures in patients after acute spine trauma, especially in an emergency clinical setting. MATERIALS AND METHODS: Our retrospective study included 31 patients presented to emergency department with suspected spine trauma. All patients underwent both DECT (80 kVp and 140 kVp) and MRI. Post-processing was performed using color-coded VNC technique. Two independent radiologists visually assessed color-coded VNC images in a random order, and one of the two readers re-assessed the images in 4 weeks after the initial assessment. They were allowed to read only color-coded VNC images and asked to determine the presence of acute fracture. To determine the standard reference point, the other two experienced radiologists made consensus readings on both grayscale CT and MRI. Sensitivity, specificity, PPV, NPV, and accuracy analyses were determined. Both intra- and inter-observer agreements were also calculated. RESULTS: A total of 217 vertebral bodies (65 thoracic and 152 lumbar vertebrae) were included in our study. Sensitivity was 83.3% and 76.7% for first and second readers, respectively. Specificity of 99.5% and 98.9%, PPV of 96.1% and 96.3%, NPV of 97.3% and 96.3%, and accuracy of 97.2% and 95.8%, respectively, were noted. Both intra-observer and inter-observer agreements indicated excellent agreement (κ = 0.86 and κ = 0.84, respectively). CONCLUSION: In spite of the relatively low sensitivity, DECT-based detection of acute spinal fractures showed good specificity, positive predictive value, negative predictive value, accuracy, and inter-/intra-observer agreements.

Automatic Lung Segmentation With Juxta-Pleural Nodule Identification Using Active Contour Model and Bayesian Approach.

OBJECTIVE: chest computed tomography (CT) images and their quantitative analyses have become increasingly important for a variety of purposes, including lung parenchyma density analysis, airway analysis, diaphragm mechanics analysis, and nodule detection for cancer screening. Lung segmentation is an important prerequisite step for automatic image analysis. We propose a novel lung segmentation method to minimize the juxta-pleural nodule issue, a notorious challenge in the applications. METHOD: we initially used the Chan-Vese (CV) model for active lung contours and adopted a Bayesian approach based on the CV model results, which predicts the lung image based on the segmented lung contour in the previous frame image or neighboring upper frame image. Among the resultant juxta-pleural nodule candidates, false positives were eliminated through concave points detection and circle/ellipse Hough transform. Finally, the lung contour was modified by adding the final nodule candidates to the area of the CV model results. RESULTS: to evaluate the proposed method, we collected chest CT digital imaging and communications in medicine images of 84 anonymous subjects, including 42 subjects with juxta-pleural nodules. There were 16 873 images in total. Among the images, 314 included juxta-pleural nodules. Our method exhibited a disc similarity coefficient of 0.9809, modified hausdorff distance of 0.4806, sensitivity of 0.9785, specificity of 0.9981, accuracy of 0.9964, and juxta-pleural nodule detection rate of 96%. It outperformed existing methods, such as the CV model used alone, the normalized CV model, and the snake algorithm. Clinical impact: the high accuracy with the juxta-pleural nodule detection in the lung segmentation can be beneficial for any computer aided diagnosis system that uses lung segmentation as an initial step.

Plasma inflammatory and immune proteins as predictors of intra-amniotic infection and spontaneous preterm delivery in women with preterm labor: a retrospective study.

BACKGROUND: We investigated whether various inflammatory and immune proteins in plasma predict intra-amniotic infection and imminent preterm delivery in women with preterm labor and compared their predictive ability with that of amniotic fluid (AF) interleukin (IL)-6 and serum C-reactive protein (CRP). METHODS: This retrospective cohort study included 173 consecutive women with preterm labor who underwent amniocentesis for diagnosis of infection and/or inflammation in the AF. The AF was cultured, and assayed for IL-6. CRP levels and cervical length by transvaginal ultrasound were measured at the time of amniocentesis. The stored maternal plasma was assayed for IL-6, matrix metalloproteinase (MMP)-9, and complements C3a and C5a using ELISA kits. The primary and secondary outcome criteria were positive AF cultures and spontaneous preterm delivery (SPTD) within 48 h, respectively. Univariate, multivariate, and receiver operating characteristic analysis were used for the statistical analysis. RESULTS: In bivariate analyses, elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery, whereas elevated plasma levels of MMP-9, C3a, and C5a were not associated with these two outcomes. On multivariate analyses, an elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery after adjusting for confounders, including high serum CRP levels and short cervical length. In predicting intra-amniotic infection, the area under the curve (AUC) was significantly lower for plasma IL-6 than for AF IL-6 but was similar to that for serum CRP. Differences in the AUCs between plasma IL-6, AF IL-6, and serum CRP were not statistically significant in predicting imminent preterm delivery. CONCLUSIONS: Maternal plasma IL-6 independently predicts intra-amniotic infection in women with preterm labor; however, it has worse diagnostic performance than that of AF IL-6 and similar performance to that of serum CRP. To predict imminent preterm delivery, plasma IL-6 had an overall diagnostic performance similar to that of AF IL-6 and serum CRP. Plasma MMP-9, C3a, and C5a levels could not predict intra-amniotic infection or imminent preterm delivery.

Widening and Rotation of Carotid Artery with Age: Geometric Approach.

BACKGROUND: The anatomy and geometry of the carotid artery may play an important role in the pathogenesis of internal carotid artery (ICA) stenosis, but the exact nature of this role remains elusive. To clarify this issue, we sought to investigate age-related changes in the anatomy and geometry of the carotid artery in a Korean population. MATERIALS AND METHODS: We conducted a retrospective study of 300 subjects who underwent carotid contrast-enhanced magnetic resonance angiography at our clinic between 2014 and 2016. The subjects were divided into 7 groups according to age. The carotid arteries were segmented using semiautomated methods to obtain various measurements of carotid anatomy and geometry, as suggested by Thomas et al. The various age groups were compared for different parameters, including ICA angle, bifurcation angle, and vessel volume and diameter. RESULTS: Analysis of variance showed that with an increase in age, there were significant increases in vessel volume and diameter of the common carotid artery and ICA as well as the carotid bifurcation (P = .000). Significant age-related increase was also noted in the ICA angle and bifurcation angle (P = .000). The anatomical position of the ICA in subjects aged over 60 years was significantly higher than that in subjects below 40 years (12.5% versus .03%, P < .0001). CONCLUSIONS: Age-related increases were noted in vessel volume and diameter of the carotid artery and ICA as well as the bifurcation angle. The widening and rotation of the carotid artery increased with age.

Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis.

BACKGROUND/AIMS: Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. METHODS: We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. RESULTS: In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). CONCLUSIONS: We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.

Endometrial polyp surveillance in premenopausal breast cancer patients using tamoxifen.

OBJECTIVE: To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use. METHODS: We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination. RESULTS: Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma. CONCLUSION: For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.

Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations.

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These recommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and imaging-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature and the consensus of experts.

Prognostic Effects of Adjuvant Chemotherapy-Induced Amenorrhea and Subsequent Resumption of Menstruation for Premenopausal Breast Cancer Patients.

Chemotherapy-induced amenorrhea (CIA) is a side effect that occurs in patients with breast cancer (BC) as a result of chemotherapy. These patients require special treatments to avoid infertility and menopause. However, the factors controlling CIA, resumption of menstruation (RM), and persistence of menstruation after chemotherapy are unknown. The long-term prognosis for premenopausal patients with BC and the prognostic factors associated with CIA and RM are subject to debate. We performed a retrospective study by reviewing the medical records of 249 patients with BC (stage I to stage III) who were treated with cytotoxic chemotherapy. The median patient age was 43 (range, 26-55 years) and the median duration of follow-up was 64 months (range, 28-100 months). The medical records indicated that 219 patients (88.0%) scored as positive for the hormone receptor (HR); the majority of these patients completed chemotherapy and then received additional therapy of tamoxifen. Our analyses revealed that 88.0% (n = 219) of patients experienced CIA, and the percentage of RM during follow-up was 48.6% (n = 121). A total of 30 patients (12.0%) did not experience CIA. Disease-free survival (DFS) was affected by several factors, including tumour size ≥2 cm, node positivity, HR negative status, and body mass index ≥23 kg/m. Multivariate analysis indicated that tumour size ≥2 cm remained as a significant factor for DFS (hazard ratio = 3.3, P = 0.034). In summary, this study finds that the majority of premenopausal patients with BC (stage I to stage III) who receive chemotherapy experience CIA and subsequent RM. Although tumour size ≥2 cm is negatively associated with DFS, RM after CIA is not associated with poor prognosis.

Usefulness of thyroglobulin measurement in needle washouts of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy.

In evaluating cervical lymph node (LN) metastasis from papillary thyroid cancer (PTC), ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) is very important tool. There were limited number of studies about the diagnostic value of thyroglubion measurement in FNAB (FNAB-Tg) in non-thyroidectomized patients. Therefore, in this study, the authors evaluated the role of FNAB-Tg in diagnosing cervical LN metastases in patients with PTC before thyroidectomy. A total 91 suspicious LNs of 68 patients were undergone US-guided FNAB-Tg and cytology. Any FNAB-Tg concentration above 50 ng/ml considered as positive, irrespective of thyroid gland presence. Based on the final pathology, 49 LNs were positive, and the remaining 42 LNs were negative for metastasis. The sensitivity, specificity, and accuracy of FNAB-Tg in thyroidectomized patients were 80.0, 100.0, and 88.9%, respectively. The diagnostic performance of FNAB-Tg was not compromised by the presence of thyroid gland (sensitivity, specificity and accuracy = 95.0, 90.9 and 93.2%, respectively). FNAB-Tg is useful and simple method for the diagnosis of metastatic cervical LNs from PTC. The diagnostic performance of FNAB-Tg was not compromised by the presence of thyroid gland. Therefore, FNAB-Tg could be performed actively for the LN staging of PTC.

Diagnostic benefit of thyroglobulin measurement in fine-needle aspiration for diagnosing metastatic cervical lymph nodes from papillary thyroid cancer: correlations with US features.

OBJECTIVE: Our goals were to determine the added value of fine-needle aspiration biopsy (FNAB)-thyroglobulin (Tg) measurements over FNAB-cytology alone for diagnosing metastatic nodes, and to determine whether the ultrasound features of lymph nodes can be used to identify lymph nodes that may benefit from FNAB-Tg measurement in patients with papillary thyroid cancer. MATERIALS AND METHODS: We retrospectively evaluated 76 surgically proven cervical lymph nodes. Twenty-nine patients were awaiting surgery and 18 patients had undergone thyroid surgery for papillary thyroid cancer. Ultrasound-guided FNAB and Tg measurements were performed and the ultrasound features were evaluated. RESULTS: The accuracies, sensitivities, and specificities of FNAB-cytology, FNAB-Tg, and combined FNAB-Tg/cytology were 90%, 80%, and 100%; 92%, 95%, and 90%; and 93%, 96%, and 90%, respectively. The diagnostic sensitivity of FNAB-Tg for metastatic nodes was significantly higher than that of FNAB-cytology (p = 0.011). Furthermore, combined FNAB-Tg/cytology significantly increased sensitivity (p = 0.002) and accuracy (p = 0.03) as compared with FNAB-cytology. CONCLUSION: Combined FNAB-Tg/cytology is significantly more sensitive and accurate at detecting metastatic nodes than FNAB-cytology alone. FNAB-Tg was better at diagnosing metastases in small lymph nodes.

Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography.

BACKGROUND: Although ultrasound (US) is routinely used for the preoperative evaluation of neck nodes in patients with papillary thyroid carcinoma (PTC), the diagnostic role of computed tomography (CT) has not been established. The purpose of our study is to determine the diagnostic accuracies of US, CT, and combined US and CT (US/CT) for detecting metastatic neck nodes in patients with PTC. METHODS: 165 consecutive patients (140 females and 25 males, mean age 47.9 years) with surgically proven PTC underwent US and CT for preoperative evaluation. CT was performed 2 or 3 months before radioiodine therapy. We assessed the diagnostic accuracies of US, CT, and US/CT using level-by-level analysis. RESULTS: In terms of predicting node metastases, overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US were 51%, 92%, 77%, 81%, and 76%, respectively. Those of CT were 62%, 93%, 81%, 84%, and 80%, respectively, and those of US/CT were 66%, 88%, 79%, 77%, and 81%, respectively, at all neck levels. US/CT significantly increased sensitivity and demonstrated similar specificity compared with US alone in lateral neck levels (p = 0.02 and p = 1.0, respectively). US/CT increased sensitivity (p = 0.01), but decreased specificity compared with US alone in the central neck levels (p = 0.02). CT provided additional benefit for detecting metastatic nodes at more than one level in 8% of all patients, in 14% of patients with suspected nodal metastasis on US, and in 25% of patients with metastatic lymph nodes. CONCLUSIONS: The US/CT combination was found to be superior to US alone for the detection of metastatic lymph nodes in the lateral neck levels in PTC patients by level-by-level analysis.