Multimodal Imaging Findings of Cerebral Amyloid Angiopathy Related Inflammation With Unusual Clinical Manifestation: A Case Report

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare encephalopathy characterized by the coexistence of a perivascular inflammatory reaction in patients with cerebral amyloid angiopathy. CAA-RI diagnosis is challenging as its final diagnosis requires invasive procedures such as autopsy or brain biopsy. Therefore, multimodal imaging approaches with clinical considerations are essential for the probable diagnosis of CAA-RI. In particular, in the case of CAA-RI presented with uncommon clinical symptoms, the need for imaging in diagnosis is further highlighted by difficulties of clinical approaches. Herein, we report a case of CAA-RI with unusual clinical manifestation diagnosed using multimodal imaging including magnetic resonance imaging (MRI) and amyloid positron emission tomography-computed tomography (PET-CT). Multimodal imaging approaches using adequate MRI sequences and PET-CT scans could facilitate the diagnosis of CAA-RI without requiring invasive pathological confirmation.

A Radiomics-Based Model for Potentially More Accurate Identification of Subtypes of Breast Cancer Brain Metastases

Purpose@#Breast cancer brain metastases (BCBM) may involve subtypes that differ from the primary breast cancer lesion. This study aimed to develop a radiomics-based model that utilizes preoperative brain MRI for multiclass classification of BCBM subtypes and to investigate whether the model offers better prediction accuracy than the assumption that primary lesions and their BCBMs would be of the same subtype (non-conversion model) in an external validation set. @*Materials and Methods@#The training and external validation sets each comprised 51 cases (102 cases total). Four machine learning classifiers combined with three feature selection methods were trained on radiomic features and primary lesion subtypes for prediction of the following four subtypes: 1) hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)-, 2) HR+/HER2+, 3) HR-/HER2+, and 4) triple-negative. After training, the performance of the radiomics-based model was compared to that of the non-conversion model in an external validation set using accuracy and F1-macro scores. @*Results@#The rate of discrepant subtypes between primary lesions and their respective BCBMs were 25.5% (n=13 of 51) in the training set and 23.5% (n=12 of 51) in the external validation set. In the external validation set, the accuracy and F1-macro score of the radiomics-based model were significantly higher than those of the non-conversion model (0.902 vs. 0.765, p=0.004; 0.861 vs. 0.699, p=0.002). @*Conclusion@#Our radiomics-based model represents an incremental advance in the classification of BCBM subtypes, thereby facilitating a more appropriate personalized therapy.

Magnetic Resonance Elastography for Clinicians and Researchers Unfamiliar With the Field

Magnetic resonance elastography (MRE) is an emerging magnetic resonance imaging (MRI) technique capable of quantitatively evaluating the biomechanical properties of tissue. MRE has been widely used in the evaluation of chronic parenchymal liver diseases.However, numerous studies have suggested its applicability in evaluating other organs.The MRE data acquisition process consists of three main steps: 1) generation of mechanical waves in soft tissues; 2) adoption of a modified phase-contrast MRI sequence to capture tissue displacements produced by the propagation of applied waves; and 3) application of an inversion algorithm to transform the wave image into maps of viscoelastic properties. As efforts are made to standardize MRE terminology and protocols, more extensive clinical investigations using MRE are expected in the future.

A Study on the Association Between the Clinical Features ofAdult Attention-Deficit/Hyperactivity Disorder and Depressive Symptoms: Focus on Korean Adult Attention-Deficit/HyperactivityDisorder Rating Scale / 신경정신의학

Objectives@#This study aimed to investigate the association between depressive symptoms and the clinical features of adult attention-deficit/hyperactivity disorder (ADHD). @*Methods@#This study included 40 adult ADHD patients, aged ≥18, who visited the outpatient clinic of the Department of Psychiatry at Ewha Womans University’s Mokdong Hospital. Patients undergoing pharmacological treatment were excluded from the sample of 243 patients. To assess the clinical features of ADHD, the Adult ADHD Self-Report Scale and the Korean Adult Attention-Deficit/Hyperactivity Disorder Rating Scale (K-AARS) were administered to the patients.Depressive symptoms were evaluated using Beck’s Depression Inventory (BDI) questionnaire.Pearson and Spearman correlation analyses were employed to explore the relationship between ADHD and depressive symptoms, and linear regression analyses were used to further investigate their associations. @*Results@#Participants were aged 19–54 years (27.47±7.05) and included a higher proportion of males (77.5%). Higher BDI scores were related to unmarried status, coexisting disorders, and lower education of the subjects. Inattention, emotional dysregulation, disorganization, impulsivity, and functional impairment measured by the K-AARS were correlated with higher BDI scores. Multiple linear regression analysis revealed significant associations between disorganization (β=0.858, p=0.008), impulsivity (β=0.759, p=0.001), emotional dysregulation (β=0.464, p<0.001), inattention (β=0.266, p=0.019), and subtotal score (β=0.069, p=0.031) in the K-AARS, and BDI. @*Conclusion@#The current study showed that elevated levels of inattention, impulsivity, disorganization, emotional dysregulation, and severity of ADHD symptoms were associated with higher levels of depressive symptoms in patients with adult ADHD. We suggest that it is important to understand the relationship between ADHD and depressive symptoms when managing adult ADHD patients with depressive symptoms.

Expectation of Medical Personnel for the Roles of the Physician Assistants in a University Hospital / 간호행정학회지

Purpose@#The purpose of this study is to clearly classify the roles of Physician assistants and to identify obstacle factors and necessary factors for the operation of the system when they are performing the roles of Physician assistants. @*Methods@#This is a descriptive research study to analyze the roles of Physician assistants and to understand the expected roles of Physician assistants according to each medical personnel (doctor, nurse, Physician assistants). @*Results@#The obstacles to work are the lack of legal protection, and unclear work guidelines, and the matter necessary for the operation of the system is the legal protection. There were statistically significant differences in health collection ability, physical examination, drug response monitoring, and reporting in terms of the differences in role expectations considered by medical professionals regarding the roles of Physician assistants. @*Conclusion@#Physician assistants need to develop various educational programs and materials, cultivate the ability to perform Physician assistants, and develop an advisory role through effective problem-solving between departments and increase the quality and satisfaction of Nursing care.

Clinicopathological differences in radiation-induced organizing hematomas of the brain based on type of radiation treatment and primary lesions

Background@#Radiation-induced organizing hematoma (RIOH) is a sporadic form of cavernous hemangioma (CH) that occurs after cerebral radiation. RIOH lesions are distinct histologically from de novo CH; however, detailed research on this subject is lacking. In the present study, the clinical and histological features of RIOHs were evaluated based on causative lesions. @*Methods@#The present study included 37 RIOHs confirmed by surgical excision from January 2009, to May 2020, in Yonsei Severance Hospital. All cases were divided into subgroups based on type of radiation treatment (gamma knife surgery [GKS], n = 24 vs. conventional radiation therapy [RT], n = 13) and pathology of the original lesion (arteriovenous malformation, n = 14; glioma, n = 12; metastasis, n = 4; other tumors, n = 7). The clinicopathological results were compared between the groups. @*Results@#Clinical data of multiplicity, latency, and size and wall thickness of the original tumors and RIOHs were analyzed. The GKS group showed shorter latency (5.85 ± 4.06 years vs. 11.15 ± 8.27 years, p = .046) and thicker tumor wall (693.7 ± 565.7 μm vs. 406.9 ± 519.7 μm, p = .049) than the conventional RT group. Significant difference was not found based on original pathology. @*Conclusions@#RIOH is more likely to occur earlier with thick tumor wall in subjects who underwent GKS than in patients who underwent conventional RT. These results indicate the clinical course of RIOH differs based on type of treatment and might help determine the duration of follow-up.

Factors Affecting Pressure Ulcer among Inpatients in Long Term Care Facilities: Adults with Cognitive Impairment / 기본간호학회지

Purpose@#The aim of this study was to identify factors affecting pressure ulcers among cognitive impairment inpatients with long term care facilities. @*Methods@#In this secondary data analysis of the two long-term care facilities, 162 patients with mild or more cognitive impairment were analyzed. Patients with a pressure ulcer of stage 2 or higher that developed after the first day of hospitalization were defined as the pressure ulcer group, while the other patients comprised the non-pressure ulcer group. Demographic characteristics were compared between the two groups. Initially, a univariate analysis was conducted. Subsequently, risk factors were identified through logistic regression analysis using the variables that exhibited statistically significant differences in the univariate analysis. @*Results@#Thirty-three patients had hospital-acquired pressure ulcers. Age (odds ratio [OR]=0.92, 95% confidence interval [CI]=0.87~0.98), albumin levels (OR=0.25, 95% CI=0.08~0.77), Charlson comorbidity index (OR=1.57, 95% CI=1.14~2.18), and Mini-Mental State Examination for Koreans score (OR=0.90, 95% CI=0.81~0.99) were identified as risk factors for pressure ulcer occurrence. @*Conclusion@#Our data analysis supports independent associations between certain clinical characteristics and pressure ulcer occurrence in long-term care facility patients with cognitive impairment. To reduce the risk of pressure ulcers in long-term care facilities, health professionals should implement appropriate prevention measures.

Dynamic Contrast-Enhanced MRI and Its Applications in Various Central Nervous System Diseases

Dynamic contrast-enhanced MRI (DCE-MRI) is a noninvasive imaging technique used to evaluate tissue vascularity/permeability features through consecutive imaging acquisitions after gadolinium-based contrast agent administration. Over the past several decades, techniques and protocols for DCE-MRI have evolved, leading to growing applications of DCE-MRI for different neurological disorders. Although most established applications of DCE-MRI are for studying tumors, an increasing number of studies have been evaluating the use of this technique for neurodegenerative and other miscellaneous diseases. The purpose of this article was to provide an overview of DCE-MRI and its clinical applications in various neurological diseases.

Quality Reporting of Radiomics Analysis in Mild Cognitive Impairment and Alzheimer’s Disease: A Roadmap for Moving Forward

Objective@#To evaluate radiomics analysis in studies on mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a radiomics quality score (RQS) system to establish a roadmap for further improvement in clinical use. @*Materials and Methods@#PubMed MEDLINE and EMBASE were searched using the terms ‘cognitive impairment’ or ‘Alzheimer’ or ‘dementia’ and ‘radiomic’ or ‘texture’ or ‘radiogenomic’ for articles published until March 2020. From 258 articles, 26 relevant original research articles were selected. Two neuroradiologists assessed the quality of the methodology according to the RQS.Adherence rates for the following six key domains were evaluated: image protocol and reproducibility, feature reduction and validation, biologic/clinical utility, performance index, high level of evidence, and open science. @*Results@#The hippocampus was the most frequently analyzed (46.2%) anatomical structure. Of the 26 studies, 16 (61.5%) used an open source database (14 from Alzheimer’s Disease Neuroimaging Initiative and 2 from Open Access Series of Imaging Studies). The mean RQS was 3.6 out of 36 (9.9%), and the basic adherence rate was 27.6%. Only one study (3.8%) performed external validation. The adherence rate was relatively high for reporting the imaging protocol (96.2%), multiple segmentation (76.9%), discrimination statistics (69.2%), and open science and data (65.4%) but low for conducting test-retest analysis (7.7%) and biologic correlation (3.8%). None of the studies stated potential clinical utility, conducted a phantom study, performed cut-off analysis or calibration statistics, was a prospective study, or conducted cost-effectiveness analysis, resulting in a low level of evidence. @*Conclusion@#The quality of radiomics reporting in MCI and AD studies is suboptimal. Validation is necessary using external dataset, and improvements need to be made to feature reproducibility, feature selection, clinical utility, model performance index, and pursuits of a higher level of evidence.

Nurses and Nursing Students' Recognition of Good Instruction

PURPOSE@#The purpose of this study was to identify and assess from nursing students and nurses in the clinical field what constitute good instruction, through the review of nursing students' opinions and clinical field demands.@*METHODS@#The study design was used Creswell's exploratory sequential design by collecting and analyzing qualitative data obtained from interviews and then analysis of quantitative data. The participations were 79 seniors in nursing schools and 85 nurses with less than three years of clinical experience. The data were collected through individual interviews and analyzed based on Elo and Kyngäs's content analysis method. The quantitative data were collected using the questionnaire developed based on qualitative results and analyzed by SPSS 23.0 program and Importance Performance Analysis (IPA).@*RESULTS@#The results showed that IPA extracted seven items with high importance but low satisfaction: “nursing fads and trends,”“teacher-learner communication and reflection,”“materials used in clinical settings such as monitoring results and test results,”“special presentations by experienced practitioners,”“instruction assures learners' comprehension,”“accurate and detailed evaluation standards” and “feedback on homework and exam.”@*CONCLUSION@#The factors comprising good instruction were verified, and the necessity for additional efforts to improve high importance and low performance factors was noted. Therefore, this study can serve as a guide for nursing education facilities and educators in developing of a thorough education system with excellent instruction designed to achieve an ideal nursing education.

Quality Reporting of Radiomics Analysis in Mild Cognitive Impairment and Alzheimer’s Disease: A Roadmap for Moving Forward

Objective@#To evaluate radiomics analysis in studies on mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a radiomics quality score (RQS) system to establish a roadmap for further improvement in clinical use. @*Materials and Methods@#PubMed MEDLINE and EMBASE were searched using the terms ‘cognitive impairment’ or ‘Alzheimer’ or ‘dementia’ and ‘radiomic’ or ‘texture’ or ‘radiogenomic’ for articles published until March 2020. From 258 articles, 26 relevant original research articles were selected. Two neuroradiologists assessed the quality of the methodology according to the RQS.Adherence rates for the following six key domains were evaluated: image protocol and reproducibility, feature reduction and validation, biologic/clinical utility, performance index, high level of evidence, and open science. @*Results@#The hippocampus was the most frequently analyzed (46.2%) anatomical structure. Of the 26 studies, 16 (61.5%) used an open source database (14 from Alzheimer’s Disease Neuroimaging Initiative and 2 from Open Access Series of Imaging Studies). The mean RQS was 3.6 out of 36 (9.9%), and the basic adherence rate was 27.6%. Only one study (3.8%) performed external validation. The adherence rate was relatively high for reporting the imaging protocol (96.2%), multiple segmentation (76.9%), discrimination statistics (69.2%), and open science and data (65.4%) but low for conducting test-retest analysis (7.7%) and biologic correlation (3.8%). None of the studies stated potential clinical utility, conducted a phantom study, performed cut-off analysis or calibration statistics, was a prospective study, or conducted cost-effectiveness analysis, resulting in a low level of evidence. @*Conclusion@#The quality of radiomics reporting in MCI and AD studies is suboptimal. Validation is necessary using external dataset, and improvements need to be made to feature reproducibility, feature selection, clinical utility, model performance index, and pursuits of a higher level of evidence.

Nurses and Nursing Students' Recognition of Good Instruction

PURPOSE@#The purpose of this study was to identify and assess from nursing students and nurses in the clinical field what constitute good instruction, through the review of nursing students' opinions and clinical field demands.@*METHODS@#The study design was used Creswell's exploratory sequential design by collecting and analyzing qualitative data obtained from interviews and then analysis of quantitative data. The participations were 79 seniors in nursing schools and 85 nurses with less than three years of clinical experience. The data were collected through individual interviews and analyzed based on Elo and Kyngäs's content analysis method. The quantitative data were collected using the questionnaire developed based on qualitative results and analyzed by SPSS 23.0 program and Importance Performance Analysis (IPA).@*RESULTS@#The results showed that IPA extracted seven items with high importance but low satisfaction: “nursing fads and trends,”“teacher-learner communication and reflection,”“materials used in clinical settings such as monitoring results and test results,”“special presentations by experienced practitioners,”“instruction assures learners' comprehension,”“accurate and detailed evaluation standards” and “feedback on homework and exam.”@*CONCLUSION@#The factors comprising good instruction were verified, and the necessity for additional efforts to improve high importance and low performance factors was noted. Therefore, this study can serve as a guide for nursing education facilities and educators in developing of a thorough education system with excellent instruction designed to achieve an ideal nursing education.

Nurses and Nursing Students' Recognition of Good Instruction

PURPOSE: The purpose of this study was to identify and assess from nursing students and nurses in the clinical field what constitute good instruction, through the review of nursing students' opinions and clinical field demands.METHODS: The study design was used Creswell's exploratory sequential design by collecting and analyzing qualitative data obtained from interviews and then analysis of quantitative data. The participations were 79 seniors in nursing schools and 85 nurses with less than three years of clinical experience. The data were collected through individual interviews and analyzed based on Elo and Kyngäs's content analysis method. The quantitative data were collected using the questionnaire developed based on qualitative results and analyzed by SPSS 23.0 program and Importance Performance Analysis (IPA).RESULTS: The results showed that IPA extracted seven items with high importance but low satisfaction: “nursing fads and trends,” “teacher-learner communication and reflection,” “materials used in clinical settings such as monitoring results and test results,” “special presentations by experienced practitioners,” “instruction assures learners' comprehension,” “accurate and detailed evaluation standards” and “feedback on homework and exam.”CONCLUSION: The factors comprising good instruction were verified, and the necessity for additional efforts to improve high importance and low performance factors was noted. Therefore, this study can serve as a guide for nursing education facilities and educators in developing of a thorough education system with excellent instruction designed to achieve an ideal nursing education.

Korean Version of the Stroke Rehabilitation Motivation Scale: Reliability and Validity Evaluation

Objective@#To translate the Stroke Rehabilitation Motivation Scale (SRMS), developed to evaluate the motivation level of stroke patients during rehabilitation, into the Korean language and to verify the reliability and validity of the Korean version of SRMS (K-SRMS). @*Methods@#The K-SRMS was developed following a structured process that included translation, verification, compromise assessment, reverse translation, feedback, and final correction. K-SRMS reliability was evaluated by performing internal consistency and test–retest analyses. The reliability test was conducted in 50 stroke patients. Its validity was assessed by comparing the K-SRMS with the scale and performing exploratory factor analysis. The validity test was conducted in 102 stroke patients. @*Results@#The test–retest analysis showed good reliability, and the internal consistency of the K-SRMS was similar to that of the original version for all, except 4, items. Thus, these 4 items were excluded, and then the validity test was conducted. Pearson correlation analysis demonstrated that the K-SRMS score was significantly correlated with the BAS total score (Pearson r=0.207, p<0.05). In the exploratory factor analysis, K-SRMS items were categorized into 7 groups (factors), and factors 1 and 4 showed mutual concordance with K-SRMS subscales, including intrinsic motivation factors and amotivation, respectively. @*Conclusion@#The newly developed K-SRMS showed good reliability and validity. It could also be used as a tool to objectify the degree of motivation for rehabilitation among stroke patients in clinical care and research.

Altered Functional Brain Networks in Patients with Traumatic Anosmia: Resting-State Functional MRI Based on Graph Theoretical Analysis

OBJECTIVE: Traumatic anosmia is a common disorder following head injury; however, little is known regarding its neural basis and influence on the functional networks. Therefore, we aimed to investigate the functional connectivity changes in patients with traumatic anosmia compared to healthy controls using resting-state functional magnetic resonance imaging (rs-fMRI). MATERIALS AND METHODS: Sixteen patients with traumatic anosmia and 12 healthy controls underwent rs-fMRI. Differences in the connectivity of the olfactory and whole brain networks were compared between the two groups. Graph theoretical parameters, such as modularity and global efficiency of the whole brain or olfactory networks, were calculated and compared. Correlation analyses were performed between the parameters and disease severity. RESULTS: Patients with traumatic anosmia showed decreased intra-network connectivity in the olfactory network (false discovery rate [FDR]-corrected p < 0.05) compared with that in healthy controls. Furthermore, the inter-network connectivity was increased in both the olfactory (FDR-corrected p < 0.05) and whole brain networks (degree-based statistic-corrected p < 0.05) in the anosmia group. The whole brain networks showed decreased modularity (p < 0.001) and increased global efficiency (p = 0.019) in patients with traumatic anosmia. The modularity and global efficiency were correlated with disease severity in patients with anosmia (p < 0.001 and p = 0.002, respectively). CONCLUSION: Traumatic anosmia increased the inter-network connectivity observed with rs-fMRI in the olfactory and global brain functional networks. rs-fMRI parameters may serve as potential biomarkers for traumatic anosmia by revealing a more widespread functional damage than previously expected.

The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study

OBJECTIVES: The effects of air pollutants on upper airway disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ENT diseases. METHODS: We identified cases of ENT disease occurring in 2009, as recorded by the Korea National Health and Nutrition Examination Survey, and explored their associations with the levels of five air pollutants: sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO), and particulate matter (PM₁₀ particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT diseases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (CI). RESULTS: A total of 7,399 subjects with ENT diseases were identified. A linear association was evident between PM₁₀ concentration and the frequency of septal deviation (Spearman coefficient, 0.507; P=0.045). After adjustment, the PM₁₀ level was associated with high odds ratios for chronic rhinosinusitis (1.22; 95% CI, 1.02 to 1.46) and septal deviation (1.43; 95% CI, 1.22 to 1.67). Both of these conditions were more prevalent in males. CONCLUSION: We found that increased ambient concentrations of PM₁₀ particles were clearly associated with increased the risk of chronic rhinosinusitis and septal deviation; the exposure-response relationship was definitive.

Functional Magnetic Resonance Imaging to Evaluate Patient Satisfaction Following Bimaxillary Surgery: A Preliminary Study

Although bimaxillary surgery enhances patients' self-esteem and mood by improving their facial appearance, surgical outcome assessments for this procedure are limited. This preliminary study investigated differences in brain activity on functional magnetic resonance imaging (fMRI) during self-face evaluation before and after bimaxillary surgery. Three patients (1 man and 2 women, age range: 20–27 years) underwent fMRI while viewing self-face images before and after bimaxillary surgery for maxillofacial deformity. The activation in the left postcentral gyrus, and medial orbital frontal cortex was significantly great in response to after-surgery self-face images compared to before-surgery images. Our preliminary results may facilitate the development of an objective measure for patient satisfaction after orthognathic surgery including bimaxillary surgery.

Joint Health Status in Hemophilia Patients Using Hemophilia Joint Health Score and Pettersson Score / 임상소아혈액종양

BACKGROUND: Comprehensive clinical and radiologic follow-up is needed to preserve joint functions and quality of life in hemophilia using clinimetric tools such as Hemophilia joint health score (HJHS) or Pettersson score (PS). We investigated the joint health status evaluated using the tools in Korean hemophilia patients. METHODS: We reviewed retrospectively medical records to collect clinical parameters, HJHS and PS, who were followed up in Severance Hospital, Seoul, Korea. The correlation between HJHS and PS, and the effect of the prophylaxis for hemophilia on the outcomes measured with the scores were evaluated. The prophylaxis proportion (PP) was calculated as the proportion of prophylaxis duration to each patient's life time. RESULTS: Total of 28 patients with severe hemophilia were enrolled. Twelve patients (42.8%) were less than 20 years old. Total of 23 patients had experienced prophylaxis during their lives, and median PP was 39.7%. There was significant correlation between HJHS and PS (P 20 years old. CONCLUSION: HJHS and PS were positively correlated. Each score increased as the patient's age increased. The prophylaxis had protective effect on joint health. The prospective evaluation of HJHS and PS will be needed to prove the effect of proper management on the joint health status.

Inter-Vendor and Inter-Session Reliability of Diffusion Tensor Imaging: Implications for Multicenter Clinical Imaging Studies

OBJECTIVE: To evaluate the inter-vendor and inter-session reliability of diffusion tensor imaging (DTI) and relevant parameters. MATERIALS AND METHODS: This prospective study included 10 healthy subjects (5 women and 5 men; age range, 25–33 years). Each subject was scanned twice using 3T magnetic resonance scanners from three different vendors at two different sites. A voxel-wise statistical analysis of diffusion data was performed using Tract-Based Spatial Statistics. Fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) values were calculated for each brain voxel using FMRIB's Diffusion Toolbox. RESULTS: A repeated measures analysis of variance revealed that there were no significant differences in FA values across the vendors or between sessions; however, there were significant differences in MD values between the vendors (p = 0.020). Although there were no significant differences in inter-session MD and inter-session/inter-vendor RD values, a significant group × factor interaction revealed differences in MD and RD values between the 1st and 2nd sessions conducted by the vendors (p = 0.004 and 0.006, respectively). CONCLUSION: Although FA values exhibited good inter-vendor and inter-session reliability, MD and RD values did not show consistent results. Researchers using DTI should be aware of these limitations, especially when implementing DTI in multicenter studies.

Dynamic Susceptibility Contrast (DSC) Perfusion MR in the Prediction of Long-Term Survival of Glioblastomas (GBM): Correlation with MGMT Promoter Methylation and 1p/19q Deletions

PURPOSE: To investigate the surgical, perfusion, and molecular characteristics of glioblastomas which influence long-term survival after treatment, and to explore the association between MR perfusion parameters and the presence of MGMT methylation and 1p/19q deletions. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board. A total 43 patients were included, all with pathologic diagnosis of glioblastoma with known MGMT methylation and 1p/19q deletion statuses. We divided these patients into long-term (≥ 60 months, n = 7) and short-term (< 60 months, n = 36) survivors, then compared surgical extent, molecular status, and rCBV parameters between the two groups using Fisher's exact test or Mann-Whitney test. The rCBV parameters were analyzed according to the presence of MGMT methylation and 1p/19q deletions. We investigated the relationship between the mean rCBV and overall survival using linear correlation. Multivariable linear regression was performed in order to find the variables related to overall survival. RESULTS: Long-term survivors (100% [7 of 7]) demonstrated a greater percentage of gross total or near total resection than short-term survivors (54.5% [18 of 33]). A higher prevalence of 1p/19q deletions was also noted among the long-term survivors (42.9% [3 of 7]) than the short-term survivors (0.0% [0 of 36]). The rCBV parameters did not differ between the long-term and short-term survivors. The rCBV values were marginally lower in patients with MGMT methylation and 1p/19q deletions. Despite no correlation found between overall survival and rCBV in the whole group, the short-term survivor group showed negative correlation (R2 = 0.181, P = 0.025). Multivariable linear regression revealed that surgical extent and 1p/19q deletions, but not rCBV values, were associated with prolonged overall survival. CONCLUSION: While preoperative rCBV and 1p/19q deletion status are related to each other, only surgical extent and the presence of 1p/19q deletion in GBM patients may predict long-term survival.