Hyon Joo Kwag

Fatty liver, insulin resistance, and features of metabolic syndrome: relationships with coronary artery calcium in 10,153 people.

OBJECTIVE Nonalcoholic fatty liver disease (NAFLD) coexists with insulin resistance (IR), but it is uncertain whether NAFLD and IR contribute independently to atherosclerosis. We tested whether fatty liver, IR, and metabolic syndrome (MetS) features (waist, glucose, triglyceride, HDL cholesterol [HDL-C], and blood pressure) were associated with a marker of atherosclerosis (coronary artery calcium [CAC] score >0), independently of cardiovascular risk factors and cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS Data were analyzed from a South Korean occupational cohort of 10,153 people who all received ultrasound measurements of fatty liver and a cardiac computed tomography CAC score. IR was defined by homeostasis model assessment of IR (HOMA-IR) ≥75th percentile. Odds ratios (ORs) (95% CIs) for the presence of a CAC score >0 were estimated using logistic regression. RESULTS There were 915 people with a CAC score >0. MetS features were increased (glucose, blood pressure, triglyceride, and waist) or decreased (HDL-C) among people with a CAC score >0 (all comparisons against CAC score ≤0; P < 0.0001). Of subjects with a CAC score >0, 55% had fatty liver and 33.7% were insulin resistant. Fatty liver (OR 1.21 [95% CI 1.01–1.45]; P = 0.04) and HOMA-IR (1.10 [1.02–1.18]; P = 0.02) were associated with CAC score >0, independently of all MetS features, conventional cardiovascular risk factors, and prior evidence of CVD. The presence of IR and fatty liver combined was associated with CAC score >0 (1.53 [1.20–1.95]; P = 0.001). CONCLUSIONS Fatty liver and HOMA-IR are both associated with a CAC score >0 (independently of each other), features of MetS, conventional cardiovascular risk factors, and existing CVD.

Hypertrophic Cardiomyopathy: Assessment with MR Imaging and Multidetector CT

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease. Its early detection is important because it is the most common cause of sudden cardiac death among young people. However, HCM is often a dilemma for clinicians because it manifests with diverse phenotypic expressions and clinical courses. With the advances in imaging technology, magnetic resonance (MR) imaging and multidetector computed tomography (CT) serve as suitable modalities for detecting and characterizing HCM and obtaining information for appropriate management of cases of HCM, although echocardiography is currently the most widely used modality. This article is an overview of the definition of HCM, its various phenotypes, risk stratification of HCM, and the potential application of cardiac MR imaging and multidetector CT for the assessment of HCM.

Are there any specific ultrasound findings of nodular hyperplasia (“leave me alone” lesion) to differentiate it from follicular adenoma?

Background: Among benign thyroid nodules, nodular hyperplasia (NH) is the most common and represents a “leave me alone” lesion with no requirement for further treatment, while follicular adenoma (FA) is a lesion that should potentially be removed due to the difficulty of differentiation from a carcinoma on a biopsy alone. Purpose: To evaluate whether there are specific ultrasound (US) findings for an NH to distinguish it from an FA. Material and Methods: Pathologically proven cases of benign thyroid nodules (95 cases: 53 NH, 42 FA) were reviewed retrospectively. The number of associated nodules, the nodule size, internal content, shape, margin, echogenicity, presence of peripheral halo, and calcification were analyzed using grayscale ultrasonography. Results: NHs were predominantly solid in 40 cases (75.5%) and predominantly cystic in 13 cases (24.5%), while FAs were predominantly solid in all cases (n=42, 100%) (P<0.001). A spongiform appearance was present exclusively in NH (9/53, 17.0%). For NH, 83.0% of the lesions (44/53) showed an isoechoic pattern. For FA, the lesions showed a variable echoic pattern, including a marked hypoechoic pattern (5/42, 11.9%), a hypoechoic pattern (22/42, 52.4%), and an isoechoic pattern (15/42, 35.7%) (P<0.001). The nodule size, shape, margin, presence of peripheral halo, and calcification did not show any difference between FA and NH. Conclusion: The ratio of solid to cystic content, spongiform appearance, and echogenicity is a combination of US findings that may be helpful in distinguishing an NH from an FA, and may thereby help to avoid unnecessary fine-needle aspirations for “leave me alone” lesions.

Reduced lung function is independently associated with increased risk of type 2 diabetes in Korean men

BackgroundReduced lung function is associated with incident insulin resistance and diabetes. The aim of this study was to assess the relationship between lung function and incident type 2 diabetes in Korean men.MethodsThis study included 9,220 men (mean age: 41.4 years) without type 2 diabetes at baseline who were followed for five years. Subjects were divided into four groups according to baseline forced vital capacity (FVC) (% predicted) and forced expiratory volume in one second (FEV1) (% predicted) quartiles. The incidence of type 2 diabetes at follow-up was compared according to FVC and FEV1 quartiles.ResultsThe overall incidence of type 2 diabetes was 2.2%. Reduced lung function was significantly associated with the incidence of type 2 diabetes after adjusting for age, BMI, education, smoking, exercise, alcohol, and HOMA-IR. Both FVC and FEV1 were negatively associated with type 2 diabetes (P < 0.05). In non-obese subjects with BMI < 25, the lowest quartile of FVC and FEV1 had a significantly higher odds ratio for type 2 diabetes compared with the highest quartile after adjusting for age and BMI (2.15 [95% CI 1.02-4.57] and 2.19 [95% CI 1.09-4.42]).ConclusionsReduced lung function is independently associated with the incidence of type 2 diabetes in Korean men.

Partially Cystic Thyroid Nodules: Ultrasound Findings of Malignancy

Objective To seek for the ultrasound (US) findings of partially cystic thyroid nodules that are associated with malignancy. Materials and Methods We reviewed the US characteristics of 22 surgically confirmed partially cystic papillary carcinomas, and compared them with those of 80 benign partially cystic nodules. The review cases were selected in a random order from a total of 1029 partially cystic nodules that were diagnosed with an US-guided fine needle aspiration biopsy over a period of 8 years (June 2003 to October 2010) at our institution. Results In partially cystic thyroid nodules, a taller-than-wide shape (100%, p < 0.001) and spiculated or microlobulated margin (58.3%, p = 0.003) were significantly associated with malignancy. In terms of internal solid portion of the nodule, eccentric configuration (68.0%, p < 0.001), non-smooth margin (81.3%, p < 0.001), hypoechogenecity (30.0%, p < 0.042), and microcalcification (89.5%, p < 0.001) were more frequently demonstrated in malignant nodules than benign ones. Conclusion In partially cystic thyroid nodules, understanding the characteristics of US findings is important to make a precise diagnosis of malignant nodules.

Ultrasound and Clinicopathological Characteristics of Triple Receptor-Negative Breast Cancers

Purpose Triple receptor-negative (TRN) breast cancer is associated with high risk of recurrence and poor prognosis. The present study assessed the clinicopathologic characteristics and ultrasound (US) features of TRN breast cancers. Methods Pathological and biological data were reviewed for 558 breast cancer patients treated at Kangbuk Samsung Hospital, between January 2003 and December 2009. The patients were separated into TRN breast cancer and non-TRN breast cancer groups, based on the results of immunohistochemical prognostic panels. Clinical and pathologic features were compared for the two groups. US features, including shape, orientation, margins, boundaries, echo patterns, posterior acoustic features, surrounding tissues, and microcalcifications, were determined for 41 TRN patients and 189 non-TRN controls (ER+/PR+/HER2-). Results Of 558 cases, 58 (10.4%) had the TRN phenotype. Four hundred and thirty-four cases (77.8%) were invasive ductal carcinomas. TRN cancer was significantly associated with specific characteristics of tumor size, nuclear grade, histologic grade, venous invasion, and lymphatic invasion. With respect to US features, TRN cancers were more likely to have an oval shape, a circumscribed margin, and marked hypoechogenicity. Conclusion Tumor characteristics were different between TRN and non-TRN breast cancers, although US cannot differentiate the subtype of breast cancers TRN cancer tend to show somewhat different US morphology.

Ultrasound elastography in the early diagnosis of plantar fasciitis

BACKGROUND The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis. MATERIAL AND METHODS We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet. RESULT Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively]. CONCLUSION US elastography is useful for the early diagnosis of plantar fasciitis.

A Case of Metachronous Metastasis to the Breast from Non-Small Cell Lung Carcinoma

Breast metastases from an extramammary primary tumor are very rare and the prognosis for such patients is generally poor. We report here on a case of a 42-year-old female with metastasis of non-small cell lung cancer to the breast, and she is now being followed up on an outpatient basis. In 2004, she presented with a solitary pulmonary nodule in the left lung, and this lesion had been noted to have gradually increased in size over time. The final pathological diagnosis was adenocarcinoma, and the diagnosis was made by performing percutaneous needle aspiration and lobectomy of the left upper lobe. Adjuvant chemotherapy and radiotherapy were given. Unfortunately, a nodule in the left breast was noted three years later, and metastatic non-small-cell lung cancer to the breast was diagnosed by excisional biopsy. Making the correct diagnosis to distinguish a primary breast carcinoma from a metastatic one is important, because the therapeutic plan and outcome for these two types of cancer are quite different.

Relationship between insulin resistance and coronary artery calcium in young men and women.

Background The gender disparity in cardiovascular disease (CVD) risk is greatest between young men and women. However, the causes of that are not fully understood. The objective of this study was to evaluate the relationship between insulin resistance and the presence of coronary artery calcium (CAC) to identify risk factors that may predispose young men and women to CVD. Methodology/Principal Findings Insulin resistance and CVD risk factors were examined in 8682 Korean men and 1829 women aged 30–45 years old. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR), and CAC was measured using computed tomography. Women were less likely to be insulin resistant (upper quartile of HOMA-IR, 18% vs. 27%, p<0.001) and had a lower prevalence of CAC (1.6% vs. 6.4%, p<0.001). Even when equally insulin resistant men and women were compared, women continued to have lower prevalence of CAC (3.1% vs. 7.2%, p = 0.004) and a more favorable CVD risk profile. Finally, after adjustment for traditional CVD risk factors, insulin resistance remained an independent predictor of CAC only in men (p = 0.03). Conclusions/Significance Young women have a lower risk for CVD and a lower CAC prevalence compared with men. This favorable CVD risk profile in women appears to occur regardless of insulin sensitivity. Unlike men, insulin resistance was not a predictor of CAC in women in this cohort. Therefore, insulin resistance has less impact on CVD risk and CAC in young women compared with men, and insulin resistance alone does not explain the gender disparity in CVD risk that is observed at an early age.

Imaging Findings of Implanted Absorbable Mesh in Patients with Breast Partial Resection

Purpose The author presents imaging findings of patients that underwent partial resection of the breast followed by absorbable mesh implantation. Materials and Methods Ultrasonographic (n = 18) and mammographic (n = 11) images of patients that had undergone absorbable mesh implantation after breast partial resection were reviewed retrospectively. Sequential changes of the lesions were analyzed in follow-up ultrasonographic examinations, focusing on the change of the size and pattern of the lesion. The presence of a mass, asymmetry, focal asymmetry, architectural distortion, and calcification were evaluated by mammography. Pathologic findings of the implanted mesh in available cases were analyzed. Results Ultrasonograms revealed a well-encapsulated anechoic lesion with (pattern 1, n = 11) or without (pattern 2, n = 5) internal isoechoic nodular portion, and a hyperechoic mass-like lesion without anechoic portion (pattern 3, n = 2). The mean length of the longest diameter decreased gradually as determined in follow-up examinations (3 months, 6.12 ± 2.599 cm; 6 months, 5.08 ± 2.105 cm; 12 months, 3.26 ± 2.206 cm). In mammograms, a mass (n = 4) was noted at the surgical site and focal asymmetry, overlapping with the postoperative change, was seen in the remaining seven cases. Pathologic findings of two cases revealed foreign body reaction. Conclusion Ultrasonography of the patients that underwent breast partial resection followed by absorbable mesh implantation showed a well-encapsulated cyst at the surgical site that gradually decreased in follow-up examinations. Adjunctive ultrasonography combined with mammography would be recommended in postoperative follow-up examinations.