Min Jeong Kim

Diagnostic Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation of Region of Interest

OBJECTIVEnThe purpose of this study was to assess the diagnostic performance of CT in the detection of intestinal ischemia associated with small-bowel obstruction using the maximal attenuation of a region of interest (ROI).nnnMATERIALS AND METHODSnAbdominal CT scans of 60 patients with small-bowel obstruction were retrospectively reviewed. The reference standard of the clinicopathologic groups was classified into four categories: no bowel necrosis, mucosal-submucosal necrosis, superficial muscle necrosis, and transmural necrosis. The viability of the small bowel on CT was evaluated by visual assessment using five categories (i.e., definitely intestinal ischemia, probably intestinal ischemia, possibly intestinal ischemia, equivocal CT results, and no intestinal ischemia) and by measurement of the maximal attenuation of an ROI at selected obstructed small-bowel loops on contrast-enhanced and unenhanced CT scans. Diagnostic performances were evaluated by one-way analysis of variance and receiver operating characteristic (ROC) curve analysis.nnnRESULTSnThe sensitivity, specificity, positive and negative predictive values, and accuracy of visual assessment for intestinal ischemia were 91.7% (33/36), 66.7% (16/24), 80.5% (33/41), 84.2% (16/19), and 81.7% (49/60), respectively. The maximal attenuation of the ROIs on contrast-enhanced CT and the subtraction value between the maximal attenuation on contrast-enhanced CT and that on unenhanced CT scans at selected bowel were significantly different according to clinicopathologic group (p < 0.001). The area under the ROC curve of the maximal attenuation subtraction values between contrast-enhanced and unenhanced CT scans (0.995) was higher than that of visual assessment (0.908) for the detection of intestinal ischemia.nnnCONCLUSIONnThe quantification of bowel wall enhancement using the maximal attenuation of an ROI was a reliable and useful method for the diagnosis of intestinal ischemia and showed good correlation with pathology results.

Doppler Sonographic Abnormalities Suggestive of Venous Congestion in the Right Lobe Graft of Living Donor Liver Transplant Recipients

OBJECTIVEnEstablishing optimal hepatic venous outflow is the key for a successful outcome of living donor liver transplantation using a right lobe graft. The purpose of this article is to illustrate the surgical techniques of middle hepatic vein reconstruction with an interposition vein graft in living donor liver transplant recipients using a modified right lobe graft, normal postoperative Doppler sonographic findings, and various Doppler sonographic abnormalities suggestive of hepatic venous congestion.nnnCONCLUSIONnHepatic venous congestion after living donor liver transplantation using a right lobe graft may produce various abnormalities on Doppler sonography. In addition to allowing the patency of the middle hepatic vein tributaries and interposition vein graft to be assessed during the early postoperative period, Doppler sonography can depict the flow direction in the portal vein and in the middle hepatic vein tributaries; therefore, Doppler sonography can reveal reversal of portal flow direction in patients with acute and severe venous congestion and can show the presence of a functional intrahepatic anastomosis between the hepatic vein tributaries during the follow-up period in those with improved congestion.

Factors Affecting the Efficacy of Ultrasound-Guided Vacuum-Assisted Percutaneous Excision for Removal of Benign Breast Lesions

This study was designed to evaluate the effectiveness of complete removal and factors affecting the presence of a residual mass and complications after ultrasound‐guided vacuum‐assisted percutaneous removal of benign breast lesions.

Intensity-modulated stereotactic body radiotherapy for stage I non-small cell lung cancer

This study aimed to investigate the clinical outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC). A prospective database of 16 consecutive patients receiving SBRT for pathologically-proven and peripherally-located stage I NSCLC was reviewed. Fifteen patients were medically inoperable and one patient refused to undergo surgery. The median age of the patients was 76 years (range, 69–86). Treatment planning used four-dimensional computed tomography and fixed-field IMRT (n=11) or volumetric-modulated arc therapy (VMAT; n=5). The SBRT scheme was 48 Gy in four fractions (n=9) or 55 Gy in five fractions (n=7), delivered on consecutive days. The overall response rate at 6 months was 78.6%, including a complete response in three (21.4%) patients and a partial response in eight (57.1%). Three patients (21.4%) demonstrated a stable disease status. The median follow-up time was 14 months (range, 6–20) for the surviving patients. One patient developed local failure at 11 months, while another suffered from regional failure in a subcarinal lymph node at 4 months. Two patients did not survive within the first 6 months; one patient died during salvage chemotherapy for mediastinal lymph node metastasis and the other succumbed to a cause unrelated to lung cancer. The Kaplan-Meier estimates of local failure-free, progression-free and overall survival rates at 18 months were 91.0, 85.2 and 87.5%, respectively. The toxicity was mild; no severe (grade ≥3) toxicity was identified. IMRT-based (including VMAT) delivery of SBRT for patients with stage I NSCLC demonstrated favorable responses and local control without severe toxicity.

What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT

The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.

Comparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer

OBJECTIVEnResponse Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0 (RECIST 1.0) was proposed as a new guideline for evaluating tumor response and has been widely accepted as a standardized measure. With a number of issues being raised on RECIST 1.0, however, a revised RECIST guideline version 1.1 (RECIST 1.1) was proposed by the RECIST Working Group in 2009. This study was conducted to compare CT tumor response based on RECIST 1.1 vs. RECIST 1.0 in patients with advanced gastric cancer (AGC).nnnMETHODSnWe reviewed 61 AGC patients with measurable diseases by RECIST 1.0 who were enrolled in other clinical trials between 2008 and 2010. These patients were retrospectively re-analyzed to determine the concordance between the two response criteria using the κ statistic.nnnRESULTSnThe number and sum of tumor diameters of the target lesions by RECIST 1.1 were significantly lower than those by RECIST 1.0 (P<0.0001). However, there was excellent agreement in tumor response between RECIST 1.1 and RECIST 1.0 (κ=0.844). The overall response rates (ORRs) according to RECIST 1.0 and RECIST 1.1 were 32.7% (20/61) and 34.5% (20/58), respectively. One patient with partial response (PR) based on RECIST 1.0 was reclassified as stable disease (SD) by RECIST 1.1. Of two patients with SD by RECIST 1.0, one was downgraded to progressive disease and the other was upgraded to PR by RECIST 1.1.nnnCONCLUSIONSnRECIST 1.1 provided almost perfect agreement with RECIST 1.0 in the CT assessment of tumor response of AGC.

A Large Amniocele with Protruded Umbilical Cord Diagnosed by 3D Ultrasound

An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.

Second-Line Irinotecan, Leucovorin, and 5-Fluorouracil for Gastric Cancer Patients after Failed Docetaxel and S-1.

Background. This retrospective study aimed to assess the efficacy and toxicities of second-line chemotherapy with irinotecan, leucovorin, and 5-fluorouracil (5-FU) in metastatic gastric cancer (MGC) patients previously treated with docetaxel and S-1 with or without oxaliplatin (DS/DOS). Patients and Methods. We reviewed the data of patients who had previously been treated with first-line DS/DOS and received biweekly irinotecan-based chemotherapy (FOLFIRI/IFL) between October 2004 and November 2011. Results. A total of 209 cycles were administered to 35 patients, with a median of 4 (range, 1–22) cycles each. The overall response rate in 29 response-assessable patients was 17.2%, including 2 complete and 3 partial responses. The median progression-free and overall survivals were 3.81 (95% confidence interval [CI], 1.82–5.80) months and 6.24 (95% CI, 1.44–11.04) months, respectively. The major grade 3/4 toxicity was neutropenia (8.6%). Conclusion. FOLFIRI/IFL chemotherapy showed modest antitumour activity and tolerable toxicities in DS/DOS-treated MGC patients.

The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases

Background The clinical diagnosis of intussusception remains challenging, because many children with intussusception may present with non-specific signs and symptoms, which overlap with other conditions. Therefore imaging, in particular ultrasonography (US), plays a significant role in the management of these patients. Purpose To evaluate how US can contribute to the diagnosis in clinically suspected intussusception and finding alternative diagnosis. Material and Methods We retrospectively reviewed reports of US examinations and medical records of 100 patients (51 boys, 49 girls; mean age, 23.0u2009±u200912.1 months) who underwent abdominal US for clinically suspected intussusception. Each US study was assessed for the presence or absence of intussusception and for a possible alternative diagnosis in cases interpreted as negative for intussusception. Results Thirty-seven patients had US findings consistent with intussusception, which was confirmed by air enema. In seven patients, US studies were normal. Alternative diagnoses were identified by US for each of the remaining 56 patients, including ileocolitis (nu2009=u200920), terminal ileitis (nu2009=u200918), mesenteric lymphadenitis (nu2009=u200913), choledochal cyst (nu2009=u20091), accessory spleen torsion (nu2009=u20091), small bowel ileus (nu2009=u20091), midgut volvulus with bowel ischemia (nu2009=u20091), and hydronephrosis (nu2009=u20091). Conclusion With the high sensitivity and specificity of this study we conclude that US is valuable in detecting intussusception and finding the alternative diagnosis.

Compression of the Main Pancreatic Duct by the Intrapancreatic-Replaced Common Hepatic Artery

We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.