Journal of the Korean Society of Radiology最新文献

The detection of progressive massive fibrosis (PMF) in regions where silicosis is endemic presents diagnostic challenges due to its resemblance to other conditions, such as lung cancer and tuberculosis on radiographs. Therefore, there is an increasing reliance on chest CT due to its higher sensitivity and specificity compared to conventional chest radiography. In this pictorial essay, we aim to illustrate the diverse manifestations of PMF on chest CT, offering valuable insights for an accurate differential diagnosis. Recognizing these manifestations is essential for improving diagnostic precision and minimizing unnecessary procedures.

Biochemical recurrence, marked by rising prostate specific antigen levels, is a common and challenging clinical scenario following curative treatments for localized prostate cancer (PCa), such as radical prostatectomy (RP) or radiation therapy (RT). An accurate assessment is critical for detecting local recurrence and distinguishing it from distant metastatic disease, thereby guiding salvage therapies. While multiparametric MRI has demonstrated strong performance in detecting local recurrence, the lack of standardized reporting has historically limited its clinical utility and reproducibility. To address this variability, an international consensus-based Prostate Imaging for Recurrence Reporting (PI-RR) system was introduced in 2021. PI-RR adopts a 5-point Likert scale, similar to Prostate Imaging Reporting and Data System, but places greater emphasis on dynamic contrast-enhanced MRI and incorporates knowledge of the prior primary tumor location to grade the likelihood of recurrence. This review article provides a comprehensive overview of the PI-RR system, detailing its imaging acquisition recommendations, specific scoring criteria after RT and RP, clinical implications, and future directions within the evolving landscape of PCa imaging.

Prostate MRI is widely employed across the clinical pathway of prostate cancer, including detection, staging, treatment planning, and surveillance. With the increasing demand for consistent and efficient image interpretation, AI has gained considerable attention as a supportive tool in prostate MRI. This review provides a task-based overview of AI applications in prostate MRI, addressing key areas such as prostate gland segmentation, cancer detection and risk stratification, local staging, disease monitoring during active surveillance, recurrence detection, and image quality assessment. Across these tasks, AI, particularly deep learning, has demonstrated promising results. Although only a limited number of AI tools for prostate MRI are commercially available, it remains essential for radiologists to understand how AI can support clinical practice, particularly as further advances are anticipated.

Since its establishment in 2012, the Medicolegal Affairs Committee of the Korean Society of Radiology (KSR) has focused on strengthening the Society's legal and institutional frameworks to protect the professional rights of radiologists. This article reviews the circumstances of the committee's establishment, its major activities, and the outcomes of its regulatory achievements, and makes suggestions regarding the committee's evolving roles and future directions in a rapidly changing medical environment. The committee has systematically revised Society's bylaws and regulations to improve consistency and transparency. It has made continuous efforts to address new challenges, including medical law revisions, introduction of AI technologies, changes in medical data utilization, and increasing medical dispute prevalence. Going forward, the committee will continue to contribute to the Society's leadership by promoting proactive and rational responses to emerging issues in medical practice, including AI and data ethics, protection of medical information, and management of intellectual property rights related to academic assets.

The perianal area consists of complex and diverse anatomical structures. Various conditions can affect this area, including inflammatory diseases, such as perianal abscesses, fistulas, and condyloma acuminata, and malignant tumors, such as mucinous adenocarcinoma, squamous cell carcinoma of the rectum, and squamous cell carcinoma of the anus. Due to the small size of the perianal area, lesions may be easily overlooked. However, with advancements in imaging technology, perianal lesions can now be identified using CT and MRI, aiding in the planning of treatment strategies. This pictorial essay aims to present the CT and MRI findings of normal anatomical structures around the anus and the inflammatory and malignant lesions affecting the perianal region. Key considerations for the detection of each condition are also discussed.

The rising detection of low-risk localized prostate cancer has established active surveillance (AS) as a standard management approach; however, reliance on repeated biopsies poses procedural risks and patient burden. Multiparametric MRI offers a noninvasive alternative for monitoring disease progression, yet the Prostate Imaging Reporting and Data System has limited capacity in interpreting longitudinal changes. To address this gap, the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) framework was developed to standardize the reporting of serial MRI changes using a 5-point scale, thereby enhancing interpretive consistency, facilitating multidisciplinary communication, and informing timely intervention. The 2024 PRECISE v2 update incorporated standardized imaging quality assessment, refined subcategories for stable disease, quantified progression criteria, and clarified comparison standards, enabling more personalized follow-up strategies. This review synthesizes the development, core features, and clinical implications of PRECISE v1 and v2, highlighting their potential to advance MRI reporting standardization and risk-adapted management in AS for prostate cancer, while outlining key areas for future research.

Bleeding from the superficial inferior epigastric artery (SIEA) following inguinal hernia repair is extremely rare. However, if such bleeding leads to hemodynamic instability, surgical or transarterial embolization (TAE) intervention is required. We report the case of a 71-year-old man who, after undergoing laparoscopic repair for a recurrent direct inguinal hernia, was referred to the interventional radiology department following active bleeding in the right inguinal area. Selective external iliac artery and SIEA angiography revealed contrast medium extravasation from the right SIEA branch. The bleeding branch was embolized using a mixture of N-butyl cyanoacrylate and iodized oil. Postembolization angiography demonstrated successful hemostasis without complications.

Gonadal shielding has been a standard practice in diagnostic radiology for more than 70 years, originally introduced to reduce hereditary risks from ionizing radiation. However, advancements in digital imaging technology have substantially decreased patient radiation doses, and epidemiological studies have not shown any significant genetic risk associated with diagnostic imaging. Current evidence suggests that the potential harms of routine patient shielding, such as increased radiation dose from automatic exposure control malfunction and the possibility of obscuring critical anatomical details, now outweigh its benefits. Consequently, major international organizations, including the American Association of Physicists in Medicine, have recommended discontinuing routine patient shielding, including gonadal and fetal shields. This review summarizes the scientific rationale for this change, outlines the updated global guidelines, and discusses strategies for education and communication to facilitate their implementation. Optimal radiation protection should be achieved through justification and protocol optimization rather than routine patient shielding.

Recently, there has been an increase in the frequency of central venous catheter insertions in multiple medical specialties. This increase has been accompanied by a higher incidence of complications, such as arterial puncture or subsequent catheter insertion. Arterial injuries resulting from inadvertent central venous catheter insertion have traditionally been managed with manual compression or open surgery. When traditional treatment methods are limited, they are supplemented with endovascular therapies such as vascular closure devices or balloon catheters. However, there are instances in which the application of these endovascular therapies is not feasible. Therefore, we aimed to present two cases in which the combination of temporary balloon tamponade and plug-based tract embolization resulted in effective treatment outcomes when conventional endovascular therapies were limited.