Mi Jung Park

Prognostic impact of sarcopenia in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone

Sarcopenia is known to be related to an increased risk of chemotherapy toxicity and to a poor prognosis in patients with malignancy. We assessed the prognostic role of sarcopenia in patients with diffuse large B‐cell lymphoma (DLBCL).

Clinical significance of the neutrophil–lymphocyte ratio in venous thromboembolism patients with lung cancer

BACKGROUND The neutrophil-lymphocyte ratio (NLR) has been identified as a potentially useful marker for predicting clinical outcome in patients with cardiovascular disease, diabetes, and various malignancies. The aim of this study was to determine whether NLR at the time of venous thromboembolism (VTE) diagnosis is a prognostic factor for the response to anticoagulation and survival in lung cancer patients treated with anticoagulation for VTE. PATIENTS AND METHODS We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 114 lung cancer patients newly diagnosed with VTE, among 991 patients pathologically confirmed for lung cancer between July 2008 and August 2013. RESULTS High NLR was significantly associated with high hematocrit (p=0.028), high C-reactive protein (p=0.002), and low albumin (p=0.001). Compared with the low NLR group, stage IV non-small cell lung cancer (NSCLC) at the time of VTE diagnosis (55.6 vs. 74.6%, p=0.055), central nervous system metastasis (5.8 vs. 25.8%, p=0.004), and cancer progression (14.3 vs. 38.8%, p=0.008) at the time of VTE diagnosis were also significant in the high NLR group. Moreover, the poor response to anticoagulation was statistically correlated with patients with NSCLC (p=0.037), high NLR (p=0.004), and low albumin (p=0.029). CONCLUSIONS The results demonstrate that the NLR at the time of VTE diagnosis could be a useful biomarker for predicting the response and prognosis following anticoagulation in patients with lung cancer and VTE.

US-guided transthoracic biopsy of peripheral lung lesions: pleural contact length influences diagnostic yield

Background Transthoracic biopsy of peripheral lung lesions under ultrasonography (US) guidance is a useful diagnostic technique. However, factors affecting diagnostic yield of US-guided transthoracic biopsy of peripheral lung lesions are not well established. Purpose To determine the factors that influence diagnostic yield of US-guided transthoracic biopsy in peripheral lung lesions. Material and Methods A total of 100 consecutive patients underwent US-guided percutaneous cutting biopsy of peripheral lung lesions from October 2007 to March 2009. After seven unconfirmed cases were excluded, 97 procedures in 93 consecutive patients were included in this study. The accuracy of the lung biopsies was assessed by comparing the biopsy results with the final diagnoses. We divided the cases into a correct group (true-positive and true-negative) and an incorrect group (false-positive, false-negative, and non-diagnostic results) and analyzed the differences in the lesions, procedures, and patient variables between the two groups. Results According to the final diagnoses, 56 cases (57.7%) were malignant and 41 cases (42.3%) were benign. An overall diagnostic accuracy of 91.8% was obtained. The median size of the lesions was 46.0 mm (interquartile range [IQR], 30.0–69.5 mm), and the median lesion-pleura contact arc length (LPCAL) was 31.0 mm (IQR, 18.0–51.0 mm). Multivariate logistic regression analysis showed that only LPCAL (odds ratio, 1.16; 95% CI, 1.04–1.30) was a significant predictor of a correct diagnosis. When we divided the lesions into those with LPCAL values >30 mm and LPCAL values ≤30 mm, the sensitivity (96.6% vs. 74.1%; P = 0.02) and the accuracy (98% vs. 85.4%; P = 0.03) were significantly higher in the group with larger LPCAL. Conclusion In US-guided transthoracic biopsy of peripheral lung lesions, the LPCAL of the lesions is an important factor for a correct diagnosis.

Mass and Fat Infiltration of Intercostal Muscles Measured by CT Histogram Analysis and Their Correlations with COPD Severity

RATIONALE AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is characterized by progressive respiratory function impairment and respiratory muscle dysfunction. We hypothesized that the mass and fat infiltration of respiratory muscles correlates with COPD severity and emphysema extent. MATERIALS AND METHODS Ninety-eight male patients with COPD underwent chest computed tomography (CT) and spirometry. The mass and fat infiltrations of intercostal and latissimus muscles were quantified as the cross-sectional area (CSA) and attenuation of these muscles using CT histogram analysis. Intercostal index and latissimus index were defined as intercostal CSAs and latissimus CSAs divided by body mass index. The emphysema extent was measured as the ratio of the emphysematous lung volume to the total lung volume using a density-mask technique. Pearson correlation analyses were performed to evaluate the relationships between these parameters. Multiple regression analysis was performed using forced expiratory volume in 1 second (FEV1) as the dependent parameter and the clinical and CT data as the independent parameters. RESULTS FEV1 was significantly correlated with intercostal index (r = 0.57), latissimus index (r = 0.34), intercostal attenuation (r = 0.62), and latissimus attenuation (r = 0.38). Emphysema extent was significantly correlated with intercostal index (r = -0.36) and intercostal attenuation (r = -0.50). Multiple regression analysis showed that FEV1 was predicted by intercostal attenuation (B = 0.40), intercostal CSA (B = 0.23), emphysema extent (B = -0.23), and age (B = -0.21, R(2) = 0.64, P < .001). CONCLUSIONS A decrease in intercostal mass and an increase in intercostal fat are associated with worsening of COPD severity.

A comparison of pectoralis versus lumbar skeletal muscle indices for defining sarcopenia in diffuse large B-cell lymphoma - two are better than one

Backgrounds Sarcopenia is known to be associated with poor clinical outcome in patients with diffuse large B-cell lymphoma (DLBCL). There is no consensus concerning the optimal method to define sarcopenia in DLBCL. Methods We retrospectively reviewed 193 DLBCL patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Sarcopenia was classified by the region where the pretreatment skeletal muscle index (SMI) was measured. Results Both the sarcopenia-L3 and sarcopenia-pectoralis muscle (PM) groups had increased incidences of severe treatment-related toxicities and treatment discontinuation compared with the non-sarcopenia-L3 and non-sarcopenia-PM groups, respectively. The sarcopenia-L3 and non-sarcopenia-L3 groups had 5-year overall survival (OS) rates of 40.5% and 67.8% (p < 0.001), respectively. The sarcopenia-PM and non-sarcopenia-PM groups had 5-year OS rates of 35.9% and 69.0% (p < 0.001), respectively. When the sarcopenia-L3 alone and sarcopenia-PM alone groups were compared, there were no differences in baseline characteristics, treatment toxicity, or survival. In multivariate analysis, when compared with the non-sarcopenia-both group, OS was significantly worse in the sarcopenia-both group (HR, 2.480; 95% CI, 1.284 – 4.792; p = 0.007), but not in patients with either sarcopenia-L3 alone or sarcopenia-PM alone (p = 0.151). Conclusions L3- and PM-SMIs are equally useful to define sarcopenia, which is related to intolerance to R-CHOP therapy and to worse survival in patients with DLBCL. More prognostic information can be obtained when these two SMIs are combined to define sarcopenia.

Ruptured extracranial carotid artery: Endovascular treatment with covered stent graft

BACKGROUND AND PURPOSE Rupture of the extracranial carotid artery is a rare, but potentially disastrous event. We aimed to review the clinical presentations and radiologic findings of this entity and to evaluate the efficacy of endovascular treatment with covered stent graft. MATERIALS AND METHODS Since January 2009, eight patients with extracranial carotid artery rupture received endovascular treatment with covered stent graft. We retrospectively reviewed their medical records and radiologic findings. RESULTS The ruptured sites were in the common carotid artery (n=5), cervical ICA (n=2) and petrous ICA (n=1), respectively. The causes of injury included spontaneous (n=2), carotid blowout syndrome (CBS) (n=2), iatrogenic (n=2) and traumatic (n=2). Technical success and immediate hemostasis were achieved in all cases. Procedure-related complications occurred in 3 patients (37.5%). In a patient, the ipsilateral angular branch of the MCA was occluded during the procedure and it was completely reopened via mechanical thrombectomy without any neurologic deficit. Minor cerebral infarction was developed in 2 patients (25%). During a mean follow-up of 334 days (range 3-2053 days), two patients died: one from recurrent CBS and the other from aspiration pneumonia. CONCLUSIONS The covered stent grafting is an effective method for the treatment of extracranial carotid artery rupture.

Splenial Lesions of the Corpus Callosum: Disease Spectrum and MRI Findings

The corpus callosum (CC) is the largest white matter structure in the brain, consisting of more than 200–250 million axons that provide a large connection mainly between homologous cerebral cortical areas in mirror image sites. The posterior end of the CC is the thickest part, which is called the splenium. Various diseases including congenital to acquired lesions including congenital anomalies, traumatic lesions, ischemic diseases, tumors, metabolic, toxic, degenerative, and demyelinating diseases, can involve the splenium of the CC and their clinical symptoms and signs are also variable. Therefore, knowledge of the disease entities and the imaging findings of lesions involving the splenium is valuable in clinical practice. MR imaging is useful for the detection and differential diagnosis of splenial lesions of the CC. In this study, we classify the disease entities and describe imaging findings of lesions involving the splenium of the CC based on our experiences and a review of the literature.

Lower Extremity Arterial Calcification as a Predictor of Coronary Atherosclerosis in Patients with Peripheral Arterial Disease

Background Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD). Objectives To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD). Patients and Methods We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD. Results LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P < 0.001). LECS significantly correlated with CCS (r = 0.831, P < 0.001) and the extent of CAD (r = 0.631, P < 0.001). Multivariate regression analysis demonstrated LECS and log-transformed CCS were independent predictors for multivessel-CAD. In receiver operating characteristic curve analysis, the diagnostic performance of LECS was 0.807 (95% confidence interval = 0.724-0.891, P < 0.001) for predicting multivessel-CAD. Conclusion Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD.

Clinical Importance of Cross‐sectional Area of Intercostal Muscles in Patients with Chronic Obstructive Pulmonary Disease

Limb muscle wasting is one of main systemic manifestation of chronic obstructive pulmonary disease (COPD). However, the change of respiratory muscle is unclear.

The oblique occipital sinus: anatomical study using bone subtraction 3D CT venography

Background and purposeAn occipital sinus draining into the sigmoid sinus has been termed the oblique occipital sinus (OOS). The frequency, anatomical features, patterns, and relationship with the transverse sinus of the oblique occipital sinus were analyzed in this study.Materials and methodsThe study included 1805 patients who underwent brain CT angiography during a 3-year period from 2013 to 2015. CT examinations were performed using a 64-slice MDCT system.ResultsThe OOS was identified in 41 patients (2.3%). There were many anatomical variations in the oblique occipital sinuses. A hypoplastic or aplastic TS was seen in 31 (75.6%) of the 41 patients with OOS.ConclusionMany anatomical variations in the oblique occipital sinus can be seen on CT venography. Some OOSs function as the main drainage route of the intracranial veins instead of the TS. Thus, careful examination is essential for preoperative evaluation in posterior fossa lesions.