Diagnostic Performance of Spin-Echo Echo-Planar Imaging Magnetic Resonance Elastography in 3T System for Noninvasive Assessment of Hepatic Fibrosis

Objective@#To validate the performance of 3T spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) for staging hepatic fibrosis in a large population, using surgical specimens as the reference standard. @*Materials and Methods@#This retrospective study initially included 310 adults (155 undergoing hepatic resection and 155 undergoing donor hepatectomy) with histopathologic results from surgical liver specimens. They underwent 3T SE-EPI MRE ≤ 3 months prior to surgery. Demographic findings, underlying liver disease, and hepatic fibrosis pathologic stage according to METAVIR were recorded. Liver stiffness (LS) was measured by two radiologists, and inter-reader reproducibility was evaluated using the intraclass correlation coefficient (ICC). The mean LS of each fibrosis stage (F0–F4) was calculated in total and for each etiologic subgroup. Comparisons among subgroups were performed using the Kruskal–Wallis test and Conover post-hoc test. The cutoff values for fibrosis staging were estimated using receiver operating characteristic (ROC) curve analysis. @*Results@#Inter-reader reproducibility was excellent (ICC, 0.98; 95% confidence interval, 0.97–0.99). The mean LS values were 1.91, 2.41, 3.24, and 5.41 kPa in F0–F1 (n = 171), F2 (n = 26), F3 (n = 38), and F4 (n = 72), respectively. The discriminating cutoff values for diagnosing ≥ F2, ≥ F3, and F4 were 2.18, 2.71, and 3.15 kPa, respectively, with the ROC curve areas of 0.97–0.98 (sensitivity 91.2%–95.9%, specificity 90.7%–99.0%). The mean LS was significantly higher in patients with cirrhosis (F4) of nonviral causes, such as primary biliary cirrhosis (9.56 kPa) and alcoholic liver disease (7.17 kPa) than in those with hepatitis B or C cirrhosis (4.28 and 4.92 kPa, respectively). There were no statistically significant differences in LS among the different etiologic subgroups in the F0–F3 stages. @*Conclusion@#The 3T SE-EPI MRE demonstrated high interobserver reproducibility, and our criteria for staging hepatic fibrosis showed high diagnostic performance. LS was significantly higher in patients with non-viral cirrhosis than in those with viral cirrhosis.

Volumetric CT Texture Analysis of Intrahepatic Mass-Forming Cholangiocarcinoma for the Prediction of Postoperative Outcomes: Fully Automatic Tumor Segmentation Versus Semi-Automatic Segmentation

Objective@#To determine whether volumetric CT texture analysis (CTTA) using fully automatic tumor segmentation can help predict recurrence-free survival (RFS) in patients with intrahepatic mass-forming cholangiocarcinomas (IMCCs) after surgical resection. @*Materials and Methods@#This retrospective study analyzed the preoperative CT scans of 89 patients with IMCCs (64 male; 25 female; mean age, 62.1 years; range, 38–78 years) who underwent surgical resection between January 2005 and December 2016. Volumetric CTTA of IMCCs was performed in late arterial phase images using both fully automatic and semi-automatic liver tumor segmentation techniques. The time spent on segmentation and texture analysis was compared, and the first-order and second-order texture parameters and shape features were extracted. The reliability of CTTA parameters between the techniques was evaluated using intraclass correlation coefficients (ICCs). Intra- and interobserver reproducibility of volumetric CTTAs were also obtained using ICCs. Cox proportional hazard regression were used to predict RFS using CTTA parameters and clinicopathological parameters. @*Results@#The time spent on fully automatic tumor segmentation and CTTA was significantly shorter than that for semiautomatic segmentation: mean ± standard deviation of 1 minutes 37 seconds ± 50 seconds vs. 10 minutes 48 seconds ± 13 minutes 44 seconds (p < 0.001). ICCs of the texture features between the two techniques ranged from 0.215 to 0.980. ICCs for the intraobserver and interobserver reproducibility using fully automatic segmentation were 0.601–0.997 and 0.177– 0.984, respectively. Multivariable analysis identified lower first-order mean (hazard ratio [HR], 0.982; p = 0.010), larger pathologic tumor size (HR, 1.171; p < 0.001), and positive lymph node involvement (HR, 2.193; p = 0.014) as significant parameters for shorter RFS using fully automatic segmentation. @*Conclusion@#Volumetric CTTA parameters obtained using fully automatic segmentation could be utilized as prognostic markers in patients with IMCC, with comparable reproducibility in significantly less time compared with semi-automatic segmentation.

The Art Therapy Experiences of Patients and Their Family Members in Hospice Palliative Care / 한국호스피스완화의료학회지

Purpose@#In this study, the researchers closely investigated the psychosocial problems faced by terminal cancer patients and their family members in hospice palliative care units. @*Methods@#The investigators conducted four sessions of art therapy intervention programs for the terminal cancer patients and their family members, carried out in-depth interviews about the influence of the cancer experience on their family function and quality of life, and analyzed their experiences using grounded theory methodology. @*Results@#After providing autonomous written informed consent, six pairs of terminally ill cancer patients and their family members, accounting for a total of 17 participants with the inclusion of additional family members who took part sporadically, took part in the art therapy intervention and interviews. The raw data, in the form of verbatim records, were analyzed according to the procedures of grounded theory (open, axial, and selective coding). Through these processes, a total of 154 concepts, 56 subcategories, and 13 categories were identified. Families were classified into four types according to their family function, quality of life, and attitude toward death. Though the art therapy intervention, patients and their family members experienced three stages over time. @*Conclusion@#This research focused on essential aspects of the family relationships and the art therapy experiences of terminal cancer patients and their family members through an art therapy intervention in the context of hospice palliative care. Based on these observations, the researchers constructed a theoretical rationale for art therapy interventions delivered to patients and their family members in the process of hospice palliative care.

The Art Therapy Experiences of Patients and Their Family Members in Hospice Palliative Care / 한국호스피스완화의료학회지

Purpose@#In this study, the researchers closely investigated the psychosocial problems faced by terminal cancer patients and their family members in hospice palliative care units. @*Methods@#The investigators conducted four sessions of art therapy intervention programs for the terminal cancer patients and their family members, carried out in-depth interviews about the influence of the cancer experience on their family function and quality of life, and analyzed their experiences using grounded theory methodology. @*Results@#After providing autonomous written informed consent, six pairs of terminally ill cancer patients and their family members, accounting for a total of 17 participants with the inclusion of additional family members who took part sporadically, took part in the art therapy intervention and interviews. The raw data, in the form of verbatim records, were analyzed according to the procedures of grounded theory (open, axial, and selective coding). Through these processes, a total of 154 concepts, 56 subcategories, and 13 categories were identified. Families were classified into four types according to their family function, quality of life, and attitude toward death. Though the art therapy intervention, patients and their family members experienced three stages over time. @*Conclusion@#This research focused on essential aspects of the family relationships and the art therapy experiences of terminal cancer patients and their family members through an art therapy intervention in the context of hospice palliative care. Based on these observations, the researchers constructed a theoretical rationale for art therapy interventions delivered to patients and their family members in the process of hospice palliative care.

Long-Term Outcome of Patients with Partially Accommodative Esotropia Who had Augmented Surgery

PURPOSE: To investigate the long-term outcome of patients with partially accommodative esotropia who had augmented surgery. METHODS: Twenty patients with partially accommodative esotropia who underwent augmented surgery were studied retrospectively. The amount of medial rectus recession was measured based on the average of the near deviation with and without spectacle correction. During the follow-up period, the changes of refractive error and angle of deviation were evaluated and the Titmus test and Worth 4-Dot test were performed. The follow-up period was at least 24 months. RESULTS: The average follow-up period was 51.6+/-18.16 months (28~86 months). Seventeen patients showed postoperative deviations of 10 PD or less, one patient was overcorrected, two patients were undercorrected. Sensory tests were performed in 17 patients. Worth 4-dot test resulted in a fusion response at far in 6 patients and at near in 8 patients. Titmus stereotest resulted in positive fly (3000 seconds of arc) in all patients and more than 80 seconds of arc in 3 patients. CONCLUSIONS: Surgical overcorrection in patients with partially accommodative esotropia who had augmented surgery is not worrisome and augmented surgery provides some degrees of stereoacuity and fusion.

The Effect of Previous Orbital Decompression on Outcome of Strabismus Surgery in Patients with Thyroid Ophthalmopathy

PURPOSE: To determine the effect of prior orbital decompression on the outcome of strabismus surgery in patients with thyroid ophthalmopathy. METHODS: The medical records of patients operated on for strabismus related to thyroid ophthalmopathy were retrospectively reviewed RESULTS: Thirty patients were included in this study. Seventeen patients had previously undergone orbital decompression, thirteen patients had not. There was no significant difference between the two groups in the average angle of preoperative horizontal or vertical deviation, the average numbers of muscle operated on, the percentage of unidirectional surgery and the outcome of strabismus surgery. CONCLUSIONS: The previous orbital decompression surgery has no significant effect on the outcome of strabismus surgery in patients with thyroid ophthalmopathy.