Assessing visibility and bone changes of spinal metastases in CT scans: a comprehensive analysis across diverse cancer types.

OBJECTIVES: To analyze the characteristics of spinal metastasis in CT scans across diverse cancers for effective diagnosis and treatment, using MRI as the gold standard. METHODS: A retrospective study of 309 patients from four centers, who underwent concurrent CT and spinal MRI, revealing spinal metastasis, was conducted. Data on metastasis including total number, volume, visibility on CT (visible, indeterminate, or invisible), and type of bone change were collected. Through chi-square and Mann-Whitney U tests, we characterized the metastasis across diverse cancers and investigated the variation in the intra-individual ratio representing the percentage of lesions within each category for each patient. RESULTS: Out of 3333 spinal metastases from 309 patients, 55% were visible, 21% indeterminate, and 24% invisible. Sclerotic and lytic lesions made up 47% and 43% of the visible and indeterminate categories, respectively. Renal cell carcinoma (RCC), prostate cancer, and hepatocellular carcinoma (HCC) had the highest visibility at 86%, 73%, and 67% (p < 0.0001, p < 0.0001, and p = 0.003), while pancreatic cancer was lowest at 29% (p < 0.0001). RCC and HCC had significantly high lytic metastasis ratios (interquartile range (IQR) 0.96-1.0 and 0.31-1.0, p < 0.001 and p = 0.005). Prostate cancer exhibited a high sclerotic lesion ratio (IQR 0.52-0.97, p < 0.001). About 39% of individuals had invisible or indeterminate lesions, even with a single visible lesion on CT. The intra-individual ratio for indeterminate and invisible metastases surpassed 18%, regardless of the maximal size of the visible metastasis. CONCLUSIONS: This study highlights the variability in characteristics of spinal metastasis based on the primary cancer type through unique lesion-centric analysis.

Dual-Layer Detector CT With Virtual Noncalcium Imaging: Diagnostic Performance in Patients With Suspected Wrist Fractures.

OBJECTIVE. The purpose of this study was to evaluate the diagnostic utility of dual-layer CT (DLCT) for evaluating wrist injuries and to compare it with MRI. MATERIALS AND METHODS. The cases of 62 patients with suspected wrist fractures who underwent imaging with both DLCT and MRI from January 2018 through February 2019 were retrospectively reviewed. By means of a calcium suppression algorithm, virtual noncalcium (VNCa) image reconstruction was performed, and the images were reviewed by two readers to identify fractures, bone contusions, and nontraumatic lesions in the radius, ulna, and carpal bones. Sensitivity, specificity, PPV, and NPV were calculated and compared between standard CT and VNCa images with a combination of standard CT and MRI as the reference standard. RESULTS. Use of DLCT with VNCa reconstruction increased the sensitivity of diagnosis of fractures in the radius and carpal bones over that of standard CT alone; occult fractures were detected that were not seen with standard CT. The sensitivity and specificity for detecting radius fracture were 98.1% and 93.8% for DLCT and 96.3% and 93.8% for standard CT. For detecting carpal bone fracture, sensitivity and specificity were 100% and 98.9% for DLCT and 93.8% and 100% for standard CT. VNCa reconstruction also had good diagnostic accuracy with regard to diagnosing nonfracture bone contusions in carpal bones. The accuracy was comparable to that of MRI with sensitivity of 92.9% and specificity of 94.5%. Interreader agreement in interpreting VNCa images was generally good to excellent. CONCLUSION. DLCT with VNCa reconstruction is a promising tool for identifying occult wrist fractures and nonfracture contusion injuries in patients with wrist trauma.

Fat-suppressed T2 mapping of human knee femoral articular cartilage: comparison with conventional T2 mapping.

BACKGROUND: There is paucity of studies applying fat suppressed (FS) technique to T2 mapping to overcome chemical shift artifacts. The purpose of the study is to difference between FS T2 and conventional T2 mapping and reproducibility of FS T2 mapping in the femoral articular cartilage. METHODS: Eighteen patients who had normal-looking femoral cartilage and underwent knee MRI with conventional T2 and FS T2 mapping were included. T2 values of each mapping were measured by two readers independently from nine regions in the medial femoral condyle (MFC) and lateral femoral condyle (LFC). Each anatomical region was divided by lines at ± 10°, 30°, 50°, 70°, 90°, and 110°. Comparisons of T2 values between conventional and FS T2 mapping were statistically analyzed. The T2 values between FS and conventional T2 mapping in the anterior, central and posterior femoral condyles were compared. RESULTS: The overall femoral condyle T2 values from the FS T2 map were significantly lower than those from the conventional T2 map (48.5ms vs. 51.0ms, p < 0.001). The differences in the T2 values between the two maps were significantly different among the three divisions of the LFC (p = 0.009) and MFC (p = 0.031). The intra-class correlation coefficients indicated higher agreement in the FS T2 map than in the conventional T2 map (0.943 vs. 0.872). CONCLUSIONS: The T2 values of knee femoral cartilage are significantly lower on FS T2 mapping than on conventional T2 mapping. FS T2 mapping is a more reproducible method for evaluating knee femoral cartilage.

Altered Composition of Microbiota in Women with Ovarian Endometrioma: Microbiome Analyses of Extracellular Vesicles in the Peritoneal Fluid.

Human microbiota refers to living microorganisms which colonize our body and crucially contribute to the metabolism of nutrients and various physiologic functions. According to recently accumulated evidence, human microbiota dysbiosis in the genital tract or pelvic cavity could be involved in the pathogenesis and/or pathophysiology of endometriosis. We aimed to investigate whether the composition of microbiome is altered in the peritoneal fluid in women with endometriosis. We recruited 45 women with histological evidence of ovarian endometrioma and 45 surgical controls without endometriosis. Following the isolation of extracellular vesicles from peritoneal fluid samples from women with and without endometriosis, bacterial genomic DNA was sequenced using next-generation sequencing of the 16S rDNA V3-V4 regions. Diversity analysis showed significant differences in the microbial community at phylum, class, order, family, and genus levels between the two groups. The abundance of Acinetobacter, Pseudomonas, Streptococcus, and Enhydrobacter significantly increased while the abundance of Propionibacterium, Actinomyces, and Rothia significantly decreased in the endometriosis group compared with those in the control group (p < 0.05). These findings strongly suggest that microbiome composition is altered in the peritoneal environment in women with endometriosis. Further studies are necessary to verify whether dysbiosis itself can cause establishment and/or progression of endometriosis.

Combined use of virtual monochromatic images and projection-based metal artifact reduction methods in evaluation of total knee arthroplasty.

OBJECTIVES: To evaluate the effect of the combined use of virtual monochromatic imaging (VMI) and projection-based metal artifact reduction (PB-MAR) methods on further artifact reduction and image quality in total knee arthroplasty (TKA) patients. METHODS: Fifty-seven knee joints from 36 patients who had a previous history of TKA for bilateral or unilateral knee joints were included in this study. Four sets of images were compared between non-MAR, PB-MAR, VMI, and VMI + PB-MAR. For quantitative analysis, the area, mean attenuation, artifact index (AI), and contrast-to-noise ratio (CNR) were calculated for each protocol. Regarding qualitative analysis, overall artifact and depiction of soft tissue and bony structure were compared using relative visual grading analysis. RESULTS: In the femoral region, the VMI + PB-MAR protocol showed the best MAR performance in quantitative measures including area, mean attenuation, and AI (p < .001). However, MAR protocols with VMI showed significantly lower CNRs than did the protocols without VMI in the tibial region (p < .001). On qualitative analysis, VMI + PB-MAR also showed fewer overall artifacts than did the other two MAR protocols. Soft tissue was best depicted in VMI + PB-MAR protocol, and PB-MAR showed the best performance for the depiction of bony structure (p < .001). CONCLUSIONS: The combined use of VMI and PB-MAR showed better MAR performance than did PB-MAR or VMI alone. In areas with severe metal artifacts, the VMI + PB-MAR and PB-MAR protocols were useful for the evaluation of soft tissue and bone structure, respectively. KEY POINTS: • The combination of artifact reduction methods is effective in reducing metal artifacts in CT. • Soft tissue was best depicted in the combined protocol of projection- and dual-energy-based methods, and projection-based protocol showed the best performance for the depiction of bone structure in case of severe metal artifacts.

Performance of a Deep Learning Algorithm in Detecting Osteonecrosis of the Femoral Head on Digital Radiography: A Comparison With Assessments by Radiologists.

OBJECTIVE. The objective of our study was to compare the sensitivity of a deep learning (DL) algorithm with the assessments by radiologists in diagnosing osteonecrosis of the femoral head (ONFH) using digital radiography. MATERIALS AND METHODS. We performed a two-center, retrospective, noninferiority study of consecutive patients (≥ 16 years old) with a diagnosis of ONFH based on MR images. We investigated the following four datasets of unilaterally cropped hip anteroposterior radiographs: training (n = 1346), internal validation (n = 148), temporal external test (n = 148), and geographic external test (n = 250). Diagnostic performance was measured for a DL algorithm, a less experienced radiologist, and an experienced radiologist. Noninferiority analyses for sensitivity were performed for the DL algorithm and both radiologists. Subgroup analysis for precollapse and postcollapse ONFH was done. RESULTS. Overall, 1892 hips (1037 diseased and 855 normal) were included. Sensitivity and specificity for the temporal external test set were 84.8% and 91.3% for the DL algorithm, 77.6% and 100.0% for the less experienced radiologist, and 82.4% and 100.0% for the experienced radiologist. Sensitivity and specificity for the geographic external test set were 75.2% and 97.2% for the DL algorithm, 77.6% and 75.0% for the less experienced radiologist, and 78.0% and 86.1% for the experienced radiologist. The sensitivity of the DL algorithm was noninferior to that of the assessments by both radiologists. The DL algorithm was more sensitive for precollapse ONFH than the assessment by the less experienced radiologist in the temporal external test set (75.9% vs 57.4%; 95% CI of the difference, 4.5-32.8%). CONCLUSION. The sensitivity of the DL algorithm for diagnosing ONFH using digital radiography was noninferior to that of both less experienced and experienced radiologist assessments.

MRI of Cuboid Pulley Lesion.

OBJECTIVE: The aim of this study was to describe cuboid pulley lesions and associated abnormalities on the basis of clinical findings and the results of MRI examinations of the ankle. MATERIALS AND METHODS: A retrospective search was performed to identify patients who had a cuboid pulley lesion during a 10-year period. A cuboid pulley lesion was defined as bone marrow edema in the lateroplantar ridge of the cuboid that was shown to be wrapped by the peroneus longus tendon on MRI of the ankle. A total of 19 patients (11 men and eight women; mean age, 45.4 years) were included in the group of patients with a cuboid pulley lesion, and 38 age-and sex-matched patients without a cuboid pulley lesion were randomly selected as the control group. We reviewed medical records and assessed MRI findings that could be associated with a cuboid pulley lesion. RESULTS: The mean (± SD) diameter of the cuboid pulley lesion was 8.9 ± 4.7 mm. Cuboid pulley lesions were associated with peroneal tenosynovitis (p < 0.001), Achilles enthesitis (p = 0.004), and a clinical diagnosis of inflammatory arthritis (p < 0.001). Eleven of the 19 patients in the group with cuboid pulley lesions had inflammatory arthritis (either rheumatoid arthritis [n = 7] or spondyloarthritis [n = 4]). The cuboid pulley lesions did not cause localized lateral foot pain and tenderness, except in one patient who had an accompanying stress fracture of the cuboid. CONCLUSION: MRI of the ankle rarely but clearly shows cuboid pulley lesions, which themselves are not likely to cause localized pain, and cuboid pulley lesions show significant associations with peroneal tenosynovitis, Achilles enthesitis, and clinically diagnosed inflammatory arthritis.

Magnetic resonance imaging follow-up of chondroid tumors: regression vs. progression.

OBJECTIVE: To present magnetic resonance imaging (MRI) evidence of the regression or progression of chondroid tumors and to investigate whether MRI can be used to predict the evolution of chondroid tumors. MATERIALS AND METHODS: Twenty-one patients with enchondromas or atypical cartilaginous tumors who had undergone extremity MRI at least twice with a minimum 12-month interval between the MRIs were enrolled in this study. The diagnosis was based on the radiography and MRI findings. We classified the tumors into the following three groups according to changes between the MRIs: no change (NC), progression (P), and regression (R). We assessed the initial MRI features, including anatomical location, size, endosteal scalloping, peritumoral edema, fat entrapment, and direction of progression or regression. Nineteen of the 21 patients had contrast-enhanced images, and we analyzed the presence of atypical lobular enhancement against typical peripheral or septal enhancement. RESULTS: The R group comprised 11 cases (52%), the P group comprised five cases (24%), and the NC group comprised five cases (24%). None of the MRI features showed statistically significant differences among the groups. Atypical lobular enhancement was observed in the R (6 of 10, 60%) and NC (2 of 5, 40%) groups but not in the P group (0 of 4, 0%), although these differences were not statistically significant. CONCLUSIONS: Chondroid tumors can either regress or progress in the MRI follow-up. Atypical lobular enhancement was seen only in stable or regressing tumors.

Assessment of pisotriquetral misalignment with magnetic resonance imaging: Is it associated with trauma?

OBJECTIVE: Our objective was to determine whether there is an association between pisotriquetral (PT) malalignment and acute distal radius fracture by using magnetic resonance imaging (MRI). METHODS: We evaluated 138 patients who underwent 3-T MRI of the wrists. Group A comprised 85 patients with acute distal radius fracture, and group B comprised 53 patients without trauma. PT interval and angle and pisiform excursion were measured on oblique axial and sagittal multiplanar reformats. The presence of abnormalities in the flexor carpi ulnaris tendon (FCU), pisometacarpal ligament (PML), and pisohamate ligament (PHL) were evaluated. RESULTS: PT interval was wider in group A on both the axial and sagittal planes (P < 0.001). Axial PT angle opened more radially in group A (P < 0.001), and the absolute value of the sagittal PT angle in group A was wider than that in group B (P = 0.006). Abnormalities in FCU, PML, and PHL were more frequently observed in group A (P < 0.001). On multiple linear regression, distal radius fracture remained significant after adjusting for the patient's age and PT osteoarthritis. CONCLUSIONS: Acute distal radius fracture can affect normal alignment of the PT joint, resulting in associated injuries to the primary PT joint stabilizers. KEY POINTS: • Acute distal radius fracture is associated with malalignment of PT joints. • Acute distal radius fracture is associated with abnormalities of PT stabilizers. • PT joint alignment can be evaluated with MRI with 3D sequences. • Wrist MRI is useful for evaluating primary PT stabilizer injuries.

Comparison of ultrasound-guided endometrial polypectomy carried out on the oocyte retrieval day and the first day of ovarian stimulation in IVF-ICSI cycles.

In this retrospective cohort study, the effect of endometrial polypectomy carried out on the day of oocyte retrieval and on the first day of ovarian stimulation in patients with a large (≥10 mm) endometrial polyp undergoing IVF and intractyoplasmic sperm injection (ICSI) was investigated and compared. A total of 74 eligible IVF-ICSI cycles in 74 women who underwent endometrial polypectomy on either the day of oocyte pick-up (late polypectomy group, 39 cycles) or the first day of ovarian stimulation (early polypectomy group, 35 cycles) between January 2007 and July 2012 were included in this study. Patient characteristics between early and late polypectomy groups were similar. Total dose and days of recombinant human FSH administered, numbers of retrieved oocytes, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and embryos transferred between the two groups were also similar, as was clinical pregnancy rate per cycle, embryo implantation rate and spontaneous abortion rate between the two groups. Therefore, endometrial polypectomy on the day of oocyte retrieval could be a more patient-friendly option for patients with a large endometrial polyp undergoing IVF-ICSI.

Computerized texture analysis of persistent part-solid ground-glass nodules: differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas.

PURPOSE: To retrospectively investigate the value of computerized three-dimensional texture analysis for differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas (IPAs) that manifest as part-solid ground-glass nodules (GGNs). MATERIALS AND METHODS: The institutional review board approved this retrospective study with a waiver of patients' informed consent. The study consisted of 86 patients with 86 pathologic analysis-confirmed part-solid GGNs (mean size, 16 mm ± 5.4 [standard deviation]) who had undergone computed tomographic (CT) imaging between January 2005 and October 2011. Each part-solid GGN was manually segmented and its computerized texture features were quantitatively extracted by using an in-house software program. Multivariate logistic regression analysis was performed to investigate the differentiating factors of preinvasive lesions from IPAs. Three-layered artificial neural networks (ANNs) with a back-propagation algorithm and receiver operating characteristic curve analysis were used to build a discriminating model with texture features and to evaluate its discriminating performance. RESULTS: Pathologic analysis confirmed 58 IPAs (seven minimally invasive adenocarcinomas and 51 invasive adenocarcinomas) and 28 preinvasive lesions (four atypical adenomatous hyperplasias and 24 adenocarcinomas in situ). IPAs and preinvasive lesions exhibited significant differences in various histograms and volumetric parameters (P < .05). Multivariate analysis revealed that smaller mass (adjusted odds ratio, 0.092) and higher kurtosis (adjusted odds ratio, 3.319) are significant differentiators of preinvasive lesions from IPAs (P < .05). With mean attenuation, standard deviation of attenuation, mass, kurtosis, and entropy, the ANNs model showed excellent accuracy in differentiation of preinvasive lesions from IPAs (area under the curve, 0.981). CONCLUSION: In part-solid GGNs, higher kurtosis and smaller mass are significant differentiators of preinvasive lesions from IPAs, and preinvasive lesions can be accurately differentiated from IPAs by using computerized texture analysis. Online supplemental material is available for this article.

Combined administration of gonadotropin-releasing hormone agonist with human chorionic gonadotropin for final oocyte maturation in GnRH antagonist cycles for in vitro fertilization.

OBJECTIVE: To evaluate the effects of combined administration of gonadotropin-releasing hormone (GnRH) agonist with human chorionic gonadotropin (hCG)for final oocyte maturation in GnRH antagonist cycles for in vitro fertilization (IVF). STUDY DESIGN: A total of 120 infertile women undergoing GnRH antagonist multiple-dose protocol for controlled ovarian stimulation were recruited and randomized into 2 groups: a study group (n=60) and a control group (n=60). For the study group, both GnRH agonist and recombinant hCG (rhCG) were injected concomitantly for final oocyte maturation when 1 or more follicles reached a mean diameter of 18 mm. For the control group, rhCG alone was administered for final oocyte maturation. RESULTS: There were no significant differences in patient characteristics. The 2 groups were also similar with respect to the number of oocytes retrieved, fertilized oocytes and good-quality embryos. Embryo implantation rate (24.7% vs. 14.9%), clinical pregnancy rate per cycle (53.3% vs. 33.3%), and live birth rate (50.0% vs. 30.0%) were significantly higher in the study group than in the control group (p = 0.006, p = 0.027, and p = 0.025, respectively). CONCLUSION: Combined administration of GnRH agonist with rhCG may be beneficial in improving endometrial receptivity and pregnancy rate in GnRH antagonist cycles for IVF.

Influence of vascular endothelial growth factor on the expression of insulin-like growth factor-II, insulin-like growth factor binding protein-2 and 5 in human luteinized granulosa cells.

The aim of the present study was to investigate the influence of vascular endothelial growth factor (VEGF) on the expression of insulin-like growth factor (IGF)-II, insulin-like growth factor binding protein (IGFBP)-2 and in cultured human luteinized granulosa cells (LGCs). Human LGCs were obtained from the follicular fluid by transvaginal oocyte aspiration from 30 infertile patients undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). The cells were cultured for 72 h with VEGF at concentrations of 0.1, 1.0, and 10.0 ng/ml. The cells not treated with VEGF served as controls. Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of IGF-II, IGFBP-2, and 5 mRNA. The expression of IGF-II mRNA in the 10.0 ng/ml of VEGF group was significantly higher than that in the control group. Treatment with 10.0 ng/ml of VEGF significantly increased the expression of IGFBP-5 mRNA than all other groups. There were no statistically significant differences in the expression of IGFBP-2 mRNA among all the groups. VEGF may play a regulator role in human ovarian physiology by modulating the expression of IGF-II and IGFBP-5 in LGCs.

Prevalence, severity, and associated factors in women in East Asia with moderate-to-severe vasomotor symptoms associated with menopause.

OBJECTIVE: To understand prevalence, severity, impact, and treatment of vasomotor symptoms associated with menopause, using cross-sectional survey data. METHODS: This online, two-part survey was conducted in East Asia among women 40-65 years recruited from established online panels (Edelman, Beijing; Hankook Research, Seoul; Rakuten Insight, Taipei) using stratified sampling. Part I collected demographics/disease characteristics, including menopausal status and vasomotor symptom severity. Women with moderate-to-severe vasomotor symptoms completed Part II, including clinical characteristics, health-related quality of life, and healthcare-seeking behavior. Primary endpoints included vasomotor symptom prevalence and severity and proportions of women eligible and willing to take hormone therapy. Results are presented for each of the three online panels separately and as a pooled total. All analyses are descriptive with no formal hypothesis testing across groups. RESULTS: Numbers of peri- versus postmenopausal women completing Part I were Edelman, 1,588 (55.1% vs 44.9%); Hankook Research, 1,000 (43.6% vs 56.4%); Rakuten Insight, 773 (61.7% vs 38.3%). Vasomotor symptom prevalence was =80% in each region; overall moderate-to-severe vasomotor symptom prevalence was 55%; >50% of women were untreated. Most of those treated used non-prescription treatments. Menopausal hormone therapy use was reported by 11.6% of peri- and 7.2% of postmenopausal women. In peri- and postmenopausal women with moderate-to-severe vasomotor symptoms, 8.6% and 3.4%, respectively, were hormone therapy-willing, 19.3% and 16.8% hormone therapy-contraindicated, 25.4% and 23.0% hormone therapy-cautious, and 10.2% and 8.3% hormone therapy-averse. Women experienced significant burden on health-related quality of life and substantial impairment of work productivity and daily activities. CONCLUSIONS: Vasomotor symptoms associated with menopause affected =80% of women aged 40 to 65 years. A substantial proportion of women are unsuitable for, or choose not to take, menopausal hormone therapy, resulting in an unmet need for nonhormonal treatment options.

Deep Radiomics-based Approach to the Diagnosis of Osteoporosis Using Hip Radiographs.

Purpose: To develop and validate deep radiomics models for the diagnosis of osteoporosis using hip radiographs. Materials and Methods: A deep radiomics model was developed using 4924 hip radiographs from 4308 patients (3632 women; mean age, 62 years ± 13 [SD]) obtained between September 2009 and April 2020. Ten deep features, 16 texture features, and three clinical features were used to train the model. T score measured with dual-energy x-ray absorptiometry was used as a reference standard for osteoporosis. Seven deep radiomics models that combined different types of features were developed: clinical (model C); texture (model T); deep (model D); texture and clinical (model TC); deep and clinical (model DC); deep and texture (model DT); and deep, texture, and clinical features (model DTC). A total of 444 hip radiographs obtained between January 2019 and April 2020 from another institution were used for the external test. Six radiologists performed an observer performance test. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Results: For the external test set, model D (AUC, 0.92; 95% CI: 0.89, 0.95) demonstrated higher diagnostic performance than model T (AUC, 0.77; 95% CI: 0.70, 0.83; adjusted P < .001). Model DC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .03) and model DTC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .048) showed improved diagnostic performance compared with model D. When observer performance without and with the assistance of the model DTC prediction was compared, performance improved from a mean AUC of 0.77 to 0.87 (P = .002). Conclusion: Deep radiomics models using hip radiographs could be used to diagnose osteoporosis with high performance.Keywords: Skeletal-Appendicular, Hip, Absorptiometry/Bone Densitometry© RSNA, 2022.

Improved diagnostic performance of plain radiography for cervical ossification of the posterior longitudinal ligament using deep learning.

BACKGROUND: A high false-negative rate has been reported for the diagnosis of ossification of the posterior longitudinal ligament (OPLL) using plain radiography. We investigated whether deep learning (DL) can improve the diagnostic performance of radiologists for cervical OPLL using plain radiographs. MATERIALS AND METHODS: The training set consisted of 915 radiographs from 207 patients diagnosed with OPLL. For the test set, we used 200 lateral cervical radiographs from 100 patients with cervical OPLL and 100 patients without OPLL. An observer performance study was conducted over two reading sessions. In the first session, we compared the diagnostic performance of the DL-model and the six observers. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) at the vertebra and patient level. The sensitivity and specificity of the DL model and average observers were calculated in per-patient analysis. Subgroup analysis was performed according to the morphologic classification of OPLL. In the second session, observers evaluated the radiographs by referring to the results of the DL-model. RESULTS: In the vertebra-level analysis, the DL-model showed an AUC of 0.854, which was higher than the average AUC of observers (0.826), but the difference was not significant (p = 0.292). In the patient-level analysis, the performance of the DL-model had an AUC of 0.851, and the average AUC of observers was 0.841 (p = 0.739). The patient-level sensitivity and specificity were 91% and 69% in the DL model, and 83% and 68% for the average observers, respectively. Both the DL-model and observers showed decreases in overall performance in the segmental and circumscribed types. With knowledge of the results of the DL-model, the average AUC of observers increased to 0.893 (p = 0.001) at the vertebra level and 0.911 (p < 0.001) at the patient level. In the subgroup analysis, the improvement was largest in segmental-type (AUC difference 0.087; p = 0.002). CONCLUSIONS: The DL-based OPLL detection model can significantly improve the diagnostic performance of radiologists on cervical radiographs.

Transvaginal ultrasound-guided radiofrequency myolysis for uterine myomas.

BACKGROUND: Myolysis is one of the procedures that is claimed to provide significant improvement in myoma status without hysterectomy. Myolysis procedures have been generally performed via laparoscopy, and there are limited data on transvaginal radiofrequency (RF) myolysis. This study investigated the feasibility, efficacy and safety of transvaginal ultrasound-guided RF myolysis. METHODS: Transvaginal ultrasound-guided RF myolysis was performed on 69 premenopausal women with symptomatic uterine myomas as an outpatient procedure. Outcomes were assessed 1, 3, 6 and 12 months after RF myolysis. Myoma volumes were measured by ulrasonography. Menorrhagia was evaluated by the number of soaked normal-sized sanitary products used per menstrual period and overall symptoms were evaluated using the symptom severity subscale of the uterine fibroids symptom questionnaire. RESULTS: Mean (± SD) age of patients was 39.8 ± 6.5 years. Mean baseline volume of the dominant myomas was 304.6 ± 229.1 cm(3) and its volume at 3 months following RF myolysis decreased compared with the previous examination (P = 0.002). An improvement of menorrhagia occurred 1, 3, 6 and 12 months after operation (all P < 0.001 versus baseline). Overall symptoms at 1, 3, 6 and 12 months after RF myolysis also improved (all P < 0.001 versus baseline). No major complications were observed or reported. After 12 months, three patients had successfully conceived and delivered and there were no complications during labor or delivery. CONCLUSIONS: Transvaginal ultrasound-guided RF myolysis might be a safe, effective and minimally invasive outpatient procedure for uterine myoma in terms of size reduction, symptom improvement and safety.

Effects on in vitro fertilization-embryo transfer outcomes of vascular endothelial growth factor receptor-1, -2 and -3 in eutopic endometrial tissue of women with endometriosis.

AIM: This study was performed to assess the expression levels of vascular endothelial growth factor receptor (VEGFR)-1, -2 and -3 mRNA in eutopic endometrial tissue and their effects on in vitro fertilization-embryo transfer (IVF-ET) outcomes in women with endometriosis. MATERIALS AND METHODS: Twenty women with endometriosis III or IV (study group) and 20 with tubal infertility only (control group) were evaluated. Controlled ovarian stimulation in all patients consisted of the long protocol using gonadotrophin-releasing hormone agonist. Prior to the administration of 0.1 mg triptorelin daily in the mid-luteal phase of the preceding menstrual cycle, a biopsy specimen was taken from the endometrial cavity, and the expression levels of VEGFR-1, -2 and -3 mRNA were analyzed with real-time reverse transcription-polymerase chain reaction. RESULTS: There were no significant differences in the numbers of retrieved oocytes and mature oocytes, fertilization rate and clinical pregnancy rate between the study and control groups. However, the implantation rate was significantly lower in the study group (P < 0.05). The relative amounts of VEGFR-1, -2 and -3 mRNA were significantly higher in the study group than in the control group (P < 0.001 each). The relative amounts of VEGFR-1 and -3 mRNA were significantly higher in the non-pregnant than in the pregnant subgroup of the study group (P < 0.01, P < 0.05, respectively). CONCLUSIONS: Increased expression of VEGFR in the endometrium, especially VEGFR-1 and -3, may be related to the development of endometriosis and may reduce the receptivity of the endometrium.

Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases.

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen's kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

Pelvic Organ Prolapse Is Associated with Osteoporosis in Korean Women: Analysis of the Health Insurance Review and Assessment Service National Patient Sample.

BACKGROUND AND OBJECTIVES: Pelvic organ prolapse (POP) and osteoporosis are major disease entities in older women that have the same epidemiology and might also have the same molecular physiology. However, few data have been reported on the relationship between POP and osteoporosis. We designed this study to examine the association between POP and osteoporosis in Korean women. MATERIALS AND METHODS: We used the Health Insurance Review and Assessment Service 2015 to 2017 National Patient Sample (HIRA-NPS). A total of 4,368,141 individuals were included in this study, and a total of 842,228 individuals aged 50 years and above were included in the final analysis. POP patients were defined by the Korean Informative Classification of Diseases (KOICD) codes (KCD-7, N81, or N99.3) and patients who underwent a pelvic reconstructive procedure. The osteoporosis patients were defined by KOICD (KCD-7, R4113, R3620, R0402,) who were prescribed osteoporosis medication. A 1:10 age-stratified matching and chi-squared test were used for statistical analysis, and p < 0.05 was considered as significant. RESULTS: A total of 7359 women were included in this analysis. Advanced POP was correlated with osteoporosis in Korean women aged 50 years and above in 2015-2017 (p < 0.0001). After adjusting for age, advanced POP was correlated with osteoporosis in the 2015, 2016, and 2017 dataset (p = 0.013, 0.0009, 0.0119, respectively). CONCLUSIONS: Advanced POP is correlated with osteoporosis in Korean women aged 50 years and above. Evaluation for osteoporosis and education about bone health can be especially important, even in relatively young women, aged 50-59 years, and POP patients.