Prediction of complete response after neoadjuvant chemotherapy for invasive breast cancers: The utility of shear wave elastography and superb microvascular imaging in pretreatment breast ultrasound.

PURPOSE: To investigate whether multiparametric parameters of pretreatment breast ultrasound (US) and clinicopathologic factors are associated with pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer. METHODS: Between November 2018 and September 2022, 88 patients who underwent NAC and subsequent surgery were included in this study (median age, 55 years; interquartile range [IQR], 45, 59.3). Multiparametric breast US including grayscale, shear wave elastography (SWE) and superb microvascular imaging (SMI) of pathologically proven invasive breast cancers were retrospectively reviewed. Clinicopathological and multiparametric parameters of breast US, including size, SWEmax, SWEratio and vascular index on SMI (SMIVI) were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine factors predicting pCR after NAC. AUROC curve analysis was performed to determine the predictors' optimal cut-off values and diagnostic performance. RESULTS: The pCR group (n = 24) showed a significantly smaller tumor size, lower SWEmax, higher Ki-67 index, higher hormone receptor negativity and negative axillary lymph node metastasis compared to the non-pCR group (n = 64). Multivariate regression analysis showed that SWEmax (adjusted odds ratio[aOR] = 0.956, 95 % confidence interval [CI] = 0.919-0.994, P = 0.025) and Ki-67 index (aOR = 1.083, 95 % CI = 1.012-1.159, P = 0.021) were independently associated with pathologically complete response. The optimal cut-off values for predicting pCR were 27.5 % for Ki-67 with an AUC of 0.743 and 134.8 kPa for SWEmax with an AUC of 0.779. A combination model including clinical factors and SWEmax showed the best diagnostic performance with an AUC of 0.876. CONCLUSION: A higher Ki-67 index and lower SWEmax measured on pretreatment breast US were independently associated with pCR in invasive breast cancer after NAC.

Utility of accelerated T2-weighted turbo spin-echo imaging with deep learning reconstruction in female pelvic MRI: a multi-reader study.

OBJECTIVES: To determine the clinical feasibility of T2-weighted turbo spin-echo (T2-TSE) imaging with deep learning reconstruction (DLR) in female pelvic MRI compared with conventional T2 TSE in terms of image quality and scan time. METHODS: Between May 2021 and September 2021, 52 women (mean age, 44 years ± 12) who underwent 3-T pelvic MRI with additional T2-TSE using a DLR algorithm were included in this single-center prospective study with patient's informed consents. Conventional, DLR, and DLR T2-TSE images with reduced scan times were independently assessed and compared by four radiologists. The overall image quality, differentiation of anatomic details, lesion conspicuity, and artifacts were evaluated using a 5-point scale. Inter-observer agreement of the qualitative scores was compared and reader protocol preferences were then evaluated. RESULTS: In the qualitative analysis of all readers, fast DLR T2-TSE showed significantly better overall image quality, differentiation of anatomic regions, lesion conspicuity, and lesser artifacts than conventional T2-TSE and DLR T2-TSE, despite approximately 50% reduction in scan time (all p < 0.05). The inter-reader agreement for the qualitative analysis was moderate to good. All readers preferred DLR over conventional T2-TSE regardless of scan time and preferred fast DLR T2-TSE (57.7-78.8%), except for one who preferred DLR over fast DLR T2-TSE (53.8% vs. 46.1%). CONCLUSION: In female pelvic MRI, image quality and accelerated image acquisition for T2-TSE can be significantly improved by using DLR compared to conventional T2-TSE. Fast DLR T2-TSE was non-inferior to DLR T2-TSE in terms of reader preference and image quality. CLINICAL RELEVANCE STATEMENT: DLR of T2-TSE in female pelvic MRI enables fast imaging along with maintaining optimal image quality compared with parallel imaging-based conventional T2-TSE. KEY POINTS: • Conventional T2 turbo spin-echo based on parallel imaging has limitations for accelerated image acquisition while maintaining good image quality. • Deep learning image reconstruction showed better image quality in both images obtained using the same or accelerated image acquisition parameters compared with conventional T2 turbo spin-echo in female pelvic MRI. • Deep learning image reconstruction enables accelerated image acquisition while maintaining good image quality in the T2-TSE of female pelvic MRI.

[Radiologic Evaluation of Uterine Lesions Using a Pattern Recognition Approach]. / 패턴 인식 ì ‘ê·¼ë²•ì„ 기반으로 한 자궁병변의 ì˜ìƒì˜í•™ì  평가.

It is important to distinguish uterine lesions from other lesions occurring in the pelvic cavity for the proper management. The primary radiological evaluation of uterine lesions is performed using transvaginal ultrasonography, and if the lesion is too large or shows atypical benign imaging findings, magnetic resonance imaging should be performed. Analyzing radiological findings of uterine lesions through a pattern recognition approach can help establish the accurate diagnosis and treatment plan. In this pictorial assay, we describe imaging characteristics of various lesions arising from the uterus and evaluate them based on the pattern recognition approach.

Longitudinal Association between L1 Trabecular Attenuation from Chest Computed Tomography (CT) and Bone Mineral Density from Dualenergy X-ray Absorptiometry (DXA).

BACKGROUND: Many studies have shown that vertebral trabecular attenuation measured on CT scan corresponds well to DXA results for bone mineral density. These studies were based on crosssectional data. Hence, there were limitations in explaining the constantly changing vertebral trabecular attenuation from CT and T-score from DXA over time. OBJECTIVE: This study aimed to determine the longitudinal association between the vertebral trabecular attenuation measured on computed tomography (CT) and the T-score measured by dual-energy X-ray absorptiometry (DXA). METHODS: We performed a database search for 333 patients who underwent surgery for breast cancer, preoperative treatment, and at least one follow-up chest CT and DXA from January, 2013 through May, 2021. One musculoskeletal radiologist measured the mean vertebral trabecular attenuation of lumbar vertebra 1(L1) on axial unenhanced images at the pedicle level by manually placing the region of interest (ROI). DXA of the lumbar spine was performed, and the lowest T-score of the lumbar spine was used for the analysis. We evaluated the association between L1 trabecular attenuation from chest CT and T-score from DXA over time using the generalized estimating equations (GEE) model to analyze longitudinal corrected data. RESULTS: A total of 150 women (mean age, 52.4 ± 11.0 years) were included. There was a statistically significant association between L1 trabecular attenuation from chest CT and T-score from DXA in the unadjusted model (p < 0.001) and adjusted model (p < 0.001). T-score value increased by 0.172 (95% confidence interval (CI): 0.145-0.200, p < 0.001) per 10 unit (HU) of L1 trabecular attenuation at time = 0 in unadjusted model and by 0.173 (95% CI: 0.143-0.203, p < 0.001) in all adjusted model. CONCLUSION: We demonstrated that L1 attenuation from chest CT images was longitudinally associated with T-score from DXA, and the degree of association appeared to be decreased over time in breast cancer patients regardless of their medical condition.

Tall cell carcinoma with reversed polarity of breast: Sonographic and magnetic resonance imaging findings.

Tall cell carcinoma with reversed polarity (TCCRP) of breast is a rare subtype of breast cancer, which show tall and columnar cells with nuclei of reversed polarity, resembles tall cell variant in papillary thyroid cancer. Only 78 cases in 20 published studies had been reported by 2021. TCCRP was recently included as a separate subgroup of rare tumors in the World Health Organization Blue Book Classification of breast tumors (5th edition). We describe a TCCRP case in a 64-year-old woman with detailed radiologic features including quantitative ultrasonography.

Analysis of Volumetric Perfusion Quantitative Parameters Using CS-VIBE Breast Dynamic Contrast Enhanced MR Imaging.

PURPOSE: To evaluate the diagnostic performance of three-dimensional volume of interest (3D-VOI) perfusion quantitative parameters using CS-VIBE DCE-MRI and investigate the relationship of the prognostic factors. MATERIALS AND METHODS: The volumetric perfusion quantitative parameters of Ktrans, Kep, Ve, Vp, of 124 pathologically proven breast masses in 93 patients were obtained using the two-compartment extended Tofts model. Also, the perfusion parameters of AUC, TTP, Emax, wash-in, and washout were automatically calculated using post-processing software. The relationship between the perfusion quantitative parameters and lesion size, pathology, and prognostic factors of malignancy was evaluated. RESULTS: Ktrans and Kep were significantly higher in the malignant than the benign lesions (p < 0.001), and the AUROC of Ktrans and Kep was 0.802 and 0.815, respectively. The area under the DCE curve, TTP, Emax, wash-in, and wash-out were significantly different between the benign and malignant lesions (p < 0.05). In multiple linear regression analysis, Ktrans and Kep were significantly different between benign and malignant tumors. Malignant tumors larger than 2cm were significantly different from those smaller than 2cm in Ktrans, Kep, Vp, area under the DCE curve, TTP, Emax, and wash-in values (p < 0.05). TTP was significantly lower in higher Ki-67 index (p < 0.05). CONCLUSION: Perfusion quantitative parameters may be applied as a feasible imaging biomarker to discriminate malignant from benign tumors. In malignant lesions, perfusion parameters were not associated with histopathological results but only in tumor size.

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Background/Aims@#While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff. @*Methods@#Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff’s perceptions of antibiotics in cancer patients with EOL. @*Results@#Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST. @*Conclusions@#Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient’s right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

Nationwide survey of internal medicine hospitalists in Korea: motivation and sustainability of a hospitalist career

Background/Aims@#Although a management fee for hospitalist service was established in Korea, the number of hospitalists required for the system to run remains outmatched. @*Methods@#In January 2020 and February 2022, before and after the establishment of the hospitalist fee system respectively, cross-sectional online surveys were conducted among internal medicine board-certified hospitalists. @*Results@#There were 59 and 64 respondents in the 2020 and 2022 surveys, respectively. The percentage of respondents who cited financial benefits as a motive for becoming a hospitalist was higher in the 2022 survey than in the 2020 survey (34.4% vs. 10.2%; p = 0.001). The annual salary of respondents was also higher in the 2022 survey than in the 2020 survey (mean, 182.9 vs. 163.0 million in South Korean Won; p = 0.006). A total of 81.3% of the respondents were willing to continue a hospitalist career in the 2022 survey. In multivariate regression analysis, the possibility of being appointed as a professor was found to be an independent predictive factor of continuing a hospitalist career (odds ratio, 4.00; 95% confidence interval, 1.09–14.75; p = 0.037). @*Conclusions@#Since the establishment of the hospitalist fee system, monetary compensation has improved for hospitalists. The possibility of being appointed as a professor could predict long-term work as hospitalists.

Feasibility of deep learning k-space-to-image reconstruction for diffusion weighted imaging in patients with breast cancers: Focus on image quality and reduced scan time.

PURPOSE: This study aimed to evaluate the feasibility of accelerated DLR (deep learning reconstruction) single-shot echo planar imaging (ss-EPI) for diffusion-weighted image (DWI) in patients with breast cancers in comparison to conventional ss-EPI. METHODS: Between August 2021 and February 2022, eighty-seven patients with pathologically proven breast cancer underwent DCE breast MRI including ss-EPI and DLR ss-EPI DWI sequences (TA, 3:36 min and 1:54 min, respectively) at 3 Tesla. In a randomized and blinded manner, two radiologists independently performed qualitative analyses for overall image quality using a 5-point scale of the following components: homogeneous fat suppression, image blurring, artifact, and lesion conspicuity. Quantitative analyses were performed by measurement of ADC values, SNR, CNR, and lesion contrast. RESULTS: DLR ss-EPI showed better image quality scores, CNR, and lesion contrast than ss-EPI (all P < 0.05) while reducing scan time by 47.2 %. DLR ss-EPI showed no significant difference in SNR and tumor ADC values compared to -ss-EPI (P = 0.307 and P = 0.123, respectively). CONCLUSIONS: DLR ss-EPI showed better results in the qualitative and quantitative analysis than conventional ss-EPI despite reducing scan time by 47.2%.

Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters.

To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden's index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.

Corrigendum: Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

This corrects the article on p. 57 in vol. 25, PMID: 35133093.

Clinical Feasibility of Shear Wave Dispersion Slope for Noninvasive Diagnosis of Nonalcoholic Steatohepatitis in Patients With Morbid Obesity: Preliminary Results Using US Shear Wave Elastography.

ABSTRACT: We aimed to investigate the clinical feasibility of shear wave dispersion slope for assessing nonalcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery.This prospective study collected data from 25 participants who received liver biopsy during bariatric surgery between February 2019 and December 2020. All participants underwent ultrasonography shear wave elastography before surgery and shear wave speed and shear wave dispersion slope were measured. Liver specimens were evaluated by 1 pathologist scored histologically for nonalcoholic fatty liver disease (NAFLD). Ultrasonography measurements were compared according to histopathologic findings. Diagnostic performance in differentiating NASH from NAFLD was evaluated using the area under the receiver operating characteristic curve (AUC). Median shear wave speed (1.48 vs 1.62 m/s, P = 0.014) and dispersion slope (8.40 vs 11.80 [m/s]/kHz, P = 0.004) were higher in NASH group than in NAFLD group. Shear wave dispersion slope tended to increase step by step as the severity of activity grade (P = 0.032) and hepatic fibrosis (P = 0.015) increased. The AUC of shear wave dispersion slope for differentiating NASH from NAFLD (AUC, 0.83; 95% confidence intervals, 0.66-1.00) was higher than that of shear wave speed (AUC, 0.78; 95% CI, 0.60-0.97), although it did not reach statistical significance (P = 0.729). Shear wave dispersion slope could be a feasible tool for assessing NASH in patients with morbid obesity.

Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

PURPOSE: Artificial intelligence (AI)-based computer-aided detection/diagnosis (CADe/x) has helped improve radiologists' performance and provides results equivalent or superior to those of radiologists' alone. This prospective multicenter cohort study aims to generate real-world evidence on the overall benefits and disadvantages of using AI-based CADe/x for breast cancer detection in a population-based breast cancer screening program comprising Korean women aged ≥ 40 years. The purpose of this report is to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of Korean women with average breast cancer risk. METHODS: Approximately 32,714 participants will be enrolled between February 2021 and December 2022 at 5 study sites in Korea. A radiologist specializing in breast imaging will interpret the mammography readings with or without the use of AI-based CADe/x. If recall is required, further diagnostic workup will be conducted to confirm the cancer detected on screening. The findings will be recorded for all participants regardless of their screening status to identify study participants with breast cancer diagnosis within both 1 year and 2 years of screening. The national cancer registry database will be reviewed in 2026 and 2027, and the results of this study are expected to be published in 2027. In addition, the diagnostic accuracy of general radiologists and radiologists specializing in breast imaging from another hospital with or without the use of AI-based CADe/x will be compared considering mammography readings for breast cancer screening. DISCUSSION: The Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM) study is a prospective multicenter study that aims to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of women with average breast cancer risk. AI-STREAM is currently in the patient enrollment phase. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05024591.

Clinical Features and Risk Factors of Adrenal Insufficiency in Patients With Cancer Admitted to the HospitalistManaged Medical Unit

Background@#The symptoms of adrenal insufficiency (AI) overlap with the common effects of advanced cancer and chemotherapy. Considering that AI may negatively affect the overall prognosis of cancer patients if not diagnosed in a timely manner, we analyzed the incidence, risk factors, and predictive methods of AI in cancer patients. @*Methods@#We retrospectively analyzed the medical records of 184 adult patients with malignancy who underwent a rapid adrenocorticotrophic hormone stimulation test in the medical hospitalist units of a tertiary hospital. Their baseline characteristics and clinical features were evaluated, and the risk factors for AI were identified using logistic regression analysis. @*Results@#Of the study patients, 65 (35%) were diagnosed with AI, in whom general weakness (63%) was the most common symptom. Multivariate logistic regression showed that eosinophilia (adjusted odds ratio [aOR], 4.28; 95% confidence interval [CI], 1.10–16.63; P = 0.036), history of steroid use (aOR, 2.37; 95% CI, 1.10–5.15; P = 0.028), and history of megestrol acetate use (aOR, 2.71; 95% CI, 1.38–5.33; P = 0.004) were associated with AI. Baseline cortisol levels of 6.2 μg/dL and 12.85 μg/dL showed a specificity of 95.0% and 95.4% for AI diagnosis, respectively. @*Conclusion@#AI was found in about one-third of patients with cancer who showed general symptoms that may be easily masked by cancer or chemotherapy, suggesting that clinical suspicion of AI is important while treating cancer patients. History of corticosteroids or megestrol acetate were risk factors for AI and eosinophilia was a pre-test predictor of AI.Baseline cortisol level appears to be a useful adjunct marker for AI.

Clinical Feasibility of High-Resolution Contrast-Enhanced Dynamic T1-Weighted Magnetic Resonance Imaging of the Upper Abdomen Using Compressed Sensing.

OBJECTIVE: The objective of this study was to evaluate the clinical feasibility of high-resolution contrast-enhanced dynamic T1-weighted imaging (T1WI) using compressed sensing (CS) in magnetic resonance imaging. METHODS: This study retrospectively included 35 patients who underwent dynamic T1WI using volumetric interpolated breath-hold examination (VIBE) with CS reconstruction (CS-VIBE) and 35 patients with conventional VIBE for comparison. Two observers assessed the liver and pancreas edges, hepatic artery, motion artifacts, and overall image quality. Quantitative analysis was performed by measuring signal intensity and image noise. RESULTS: The results showed that CS-VIBE achieved significantly better anatomic delineation of the liver and pancreas edges and hepatic artery clarity than VIBE (P < 0.001). There were no significant differences in motion artifacts in dynamic phases and overall image quality. The signal intensities and INs of CS-VIBE were higher than VIBE. CONCLUSIONS: High-resolution dynamic T1WI using CS provides better anatomic delineation with comparable or better overall image quality than conventional VIBE.

Modified Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Prostate: Comparison With Reduced Field-of-View Imaging and Single Shot Echo-Planar Imaging.

OBJECTIVE: The objective of this study was to compare the image quality and apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) with modified reduced field of view (FOV) based on 2-dimensional (2D)-selective radiofrequency excitations by tilting the excitation plane in prostate with reduced FOV using parallel-transmit-accelerated 2D-selective radiofrequency excitation and single-shot echo planar imaging (ssEPI). METHODS: Fifty patients who underwent multiparametric magnetic resonance imaging including 3 DWIs were included. Two observers independently performed qualitative image analyses using 5-point scale. Apparent diffusion coefficient measurements were performed for quantitative analysis. RESULTS: Modified reduced FOV provided the highest qualitative scores for all categories compared with reduced FOV and ssEPI (P < 0.000). Both reduced FOV DWIs showed higher ADC values compared with ssEPI (P < 0.001); however, the ADC ratios between the lesion and peripheral zone were not significantly different (all P > 0.05). CONCLUSIONS: The modified reduced FOV DWI showed better overall image quality, differentiability of anatomic regions, and lesion conspicuity with fewer artifacts compared with DWI with reduced FOV and ssEPI.

Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses.

PURPOSE: This study aimed to evaluate the reproducibility and diagnostic performance of a quantitative parameter of superb microvascular imaging (SMI) in real-time breast ultrasonography (US) for differentiating benign from malignant breast masses. METHODS: Eighty-seven breast masses in 75 patients who underwent both B-mode US and SMI before US-guided core needle biopsy were included in this study. Two radiologists performed B-mode US and measured the vascular index (VI) of SMI respectively for each lesion in real time. Intraobserver and interobserver agreements were analyzed for the VI of SMI. The diagnostic performance of B-mode US using the Breast Imaging Reporting and Database System lexicon and combined use with the VI of SMI was evaluated compared to pathology. RESULTS: The median VI of malignant masses (n=32) was significantly higher than that of benign masses (n=55) (7.6% and 2.6%, respectively; P<0.001). The intraobserver agreement for VI was excellent regardless of the pathology, size, or depth of the lesion. The interobserver agreement for VI was excellent regardless of the presence of a measurement interval. The interobserver agreement for the final diagnostic decision was improved by combining B-mode US and VI (κ=0.883) in comparison with B-mode US only (κ=0.617). Adding VI led to significant improvements in the specificity (87.2% vs. 52.7%, 83.6% vs. 49.0%), accuracy (89.7% vs. 69.3%, 84.0% vs. 65.9%) and positive predictive value (81.5% vs. 55.1%, 75.6% vs. 52.6%) of B-mode US for both observers compared with B-mode US alone (all, P=0.001). CONCLUSION: The VI of SMI for real-time breast US is highly reproducible and leads to improved diagnostic performance for differentiating between benign and malignant breast lesions in combination with B-mode US.

Long-Term Follow-Up Ultrasonographic Findings of Intrathyroidal Thymus in Children.

OBJECTIVE: To analyze long-term follow-up sonographic findings of intrathyroidal thymus in children. MATERIALS AND METHODS: Among 1259 patients with congenital hypothyroidism under 15 years of age who underwent thyroid ultrasonography (US), 41 patients were diagnosed with an intrathyroidal thymus based on US criteria, i.e., hypoechoic solid lesion with punctate and linear echogenicity. In 26 patients aged one to 14 years old, the last follow-up US was performed after 6 to 132 months and compared with the initial US. The lesion was considered to decrease in size if there was a change of more than 2 mm in any dimension. The margin change was divided into well-defined and indistinct, blurred. When the echogenicity changed to a hyperechoic from a characteristic thymic echogenicity pattern, the pattern was considered a hyperechogenic. The changes in size were compared with the changes in shape, margin, and echogenicity pattern. The changes in size, shape, margin, and echogenicity were analyzed the association with the age of last follow-up. Statistical analysis was conducted using the chi-squared test and logistic regression. RESULTS: Fifteen (57.7%) cases were stable in size, and 11 (42.3%) decreased in size, including one that disappeared. Ten (38.5%) cases changed to indistinct margins from initially well-defined margins including one case of initially indistinct margin. Six (23.1%) changed to hyperechogenic, from initially characteristic thymic echogenicity patterns. When follow-up change was compared, decreases in size were significantly associated with lesion changes to indistinct margins (p = 0.004). The age at last follow-up was significantly associated with change to hyperechogenicity (odd ratio, 2.141; 95% confidence interval, 1.144-4.010, p = 0.017). CONCLUSION: On follow-up US, an intrathyroidal thymus may be decreased in size, with indistinct margins, or show changes to a hyperechoic mass. Decreases in size may be associated with changing to indistinct margins, and changes to hyperechogenicity may be associated with increasing age.

Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses.

OBJECTIVE: This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear wave elastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign and malignant breast masses. MATERIALS AND METHODS: A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewed using breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting and data system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and the vascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US with SWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively. Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 and downgrading of category 4a (set 2) were calculated. RESULTS: Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. In set 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively) than B-mode alone (0.719) (p < 0.001 and p = 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVI had the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0% to 84.0% (p < 0.001) and from 46.1% to 79.1% (p < 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6% without statistical loss (p = 0.199). CONCLUSION: Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance in differentiating between benign and malignant breast lesions.

Inhibition of Ceramide Accumulation in Podocytes by Myriocin Prevents Diabetic Nephropathy

Background@#Ceramides are associated with metabolic complications including diabetic nephropathy in patients with diabetes.Recent studies have reported that podocytes play a pivotal role in the progression of diabetic nephropathy. Also, mitochondrial dysfunction is known to be an early event in podocyte injury. Thus, we tested the hypothesis that ceramide accumulation in podocytes induces mitochondrial damage through reactive oxygen species (ROS) production in patients with diabetic nephropathy. @*Methods@#We used Otsuka Long Evans Tokushima Fatty (OLETF) rats and high-fat diet (HFD)-fed mice. We fed the animals either a control- or a myriocin-containing diet to evaluate the effects of the ceramide. Also, we assessed the effects of ceramide on intracellular ROS generation and on podocyte autophagy in cultured podocytes. @*Results@#OLETF rats and HFD-fed mice showed albuminuria, histologic features of diabetic nephropathy, and podocyte injury, whereas myriocin treatment effectively treated these abnormalities. Cultured podocytes exposed to agents predicted to be risk factors (high glucose, high free fatty acid, and angiotensin II in combination [GFA]) showed an increase in ceramide accumulation and ROS generation in podocyte mitochondria. Pretreatment with myriocin reversed GFA-induced mitochondrial ROS generation and prevented cell death. Myriocin-pretreated cells were protected from GFA-induced disruption of mitochondrial integrity. @*Conclusion@#We showed that mitochondrial ceramide accumulation may result in podocyte damage through ROS production.Therefore, this signaling pathway could become a pharmacological target to abate the development of diabetic kidney disease.