Journal of the Korean Society of Radiology最新文献

Transarterial radioembolization (TARE) is a minimally invasive treatment modality for hepatocellular carcinoma (HCC) that delivers targeted radiation via radioactive microspheres. The procedure entails selective catheterization of the hepatic artery, followed by infusion of yttrium-90-labeled microspheres directly into the arterial supply of the tumor. Several technical strategies are employed to optimize precise radiation delivery while minimizing exposure to surrounding healthy liver tissue. Post-procedure imaging is crucial for assessing therapeutic efficacy. Contrast-enhanced CT or MRI is routinely performed to evaluate tumor response, which may manifest as reductions in tumor size, decreased vascularity, or increased necrosis. It is important to recognize that radioembolization-induced changes in the liver parenchyma can mimic tumor recurrence, which may lead to unnecessary additional interventions if misinterpreted. Follow-up imaging also plays an essential role in identifying potential complications, including non-target radiation injury and disease progression. Overall, TARE has demonstrated promising outcomes in improving survival and quality of life for patients with HCC, establishing itself as a valuable option within the multidisciplinary management of liver cancer.

Iatrogenic rupture of the iliac artery during endovascular intervention is a rare but potentially serious complication of vascular interventional procedures that can lead to hemorrhagic shock and death if not diagnosed early and treated promptly. A 51-year-old man underwent transcatheter arterial chemoembolization for hepatocellular carcinoma. During the procedure, the right common iliac artery ruptured, which was identified by extravasation of contrast media on angiography. Urgent balloon tamponade was performed for 20 minutes, followed by contralateral femoral access, and distal aorta ballooning was performed to stabilize the hemodynamics; during ballooning, a balloon-expandable stent graft was deployed from the ipsilateral side. The patient's vital signs stabilized without complications. This report highlights the importance of prompt recognition and management of iatrogenic vascular injuries during endovascular procedures as well as the efficacy of balloon tamponade, distal aorta ballooning, and stent-graft placement in achieving hemostasis and patient stabilization.

Neurogenic ptosis refers to upper eyelid drooping resulting from disrupted innervation of the eyelid retractor muscles. The differential diagnoses of neurogenic ptosis include oculomotor nerve palsy, Horner's syndrome, and neuromuscular junction disorders. Oculomotor nerve palsy and Horner's syndrome result from damage to the oculomotor and oculosympathetic pathways, respectively. The oculomotor nerve pathway has four segments: intraaxial, subarachnoid, cavernous, and orbital. The oculosympathetic pathway consists of three orders of neurons extending from the base of the skull to the upper chest. Several pathologic conditions can affect these neural pathways and cause neurogenic ptosis owing to the long course of the involved nerves. Therefore, neurogenic ptosis is usually associated with unique clinical features based on the anatomical location of the pathology. This pictorial essay provides a deeper understanding of the neural pathways and different diseases that cause neurogenic ptosis, which can help in determining the location of the pathology.

Purpose: We aimed to apply artificial intelligence (AI)-based segmentation techniques to low-dose chest CT images to measure the muscle mass and investigate whether these results can be helpful in diagnosing sarcopenia.

Materials and methods: We retrospectively included 100 participants who had undergone both routine-dose contrast-enhanced chest CT (routine CT) and low-dose chest CT (LDCT) within 6 months of the study. Muscle segmentation and measurement were performed using a commercially available AI-based software. Skeletal muscle volume index (SMVI, g/m²) and skeletal muscle index (L1 SMI, cm²/m²) were measured on CT images using the software. We compared the SMVI obtained through routine CT and LDCT in the same patients and investigated the correlation between SMVI and L1 SMI.

Results: The SMVI obtained through both routine CT and LDCT demonstrated statistically significant associations with the conventional L1 SMI (r = 0.89, 0.85, p < 0.001). The SMVI obtained through LDCT showed a slightly lower value but maintained a high correlation with SMVI obtained through routine CT (r = 0.956, p < 0.001).

Conclusion: Utilization of the LDCT protocol in diagnosing sarcopenia appears to be a valuable approach. By applying AI-based segmentation to these scans, it has become possible to accurately measure the entire muscle mass.

Purpose: To verify the efficacy of preoperative embolization in patients with bladder cancer at ≥T2 stage or a vesical imaging-reporting and data system (VI-RADS) score of ≥3 who require transurethral resection of bladder tumor (TURBT).

Materials and methods: Initially, 1707 patients diagnosed with bladder cancer were selected using CT and MRI between January 2018 and October 2023. After applying the inclusion criteria of ≥T2 stage, VI-RADS score ≥3, and having undergone TURBT, 128 patients were included (28 with and 100 without preoperative embolization). Propensity score matching (PSM) minimized selection bias. Differences in the preoperative and postoperative hemoglobin (Hb) levels (Hb gap) between patients with and without preoperative embolization were analyzed.

Results: During PSM, comparisons adjusted by propensity scores were conducted using data from 28 patients per group (without preoperative embolization: 24 men and 4 women; mean age: 81.0 years; pathological stage: T1 [60.7%], T2 [39.3%]; with preoperative embolization: 25 men and 3 women; mean age: 81.0 years; pathological stage: T1 [53.6%], T2 [42.9%], T3 [3.6%]). An independent samples t-test revealed that the mean Hb gap was -0.90 and -1.30 (g/dL) in the groups with and without preoperative embolization, respectively (p = 0.045).

Conclusion: Preoperative embolization was beneficial for postoperative Hb level management in patients at ≥T2 stage and with a VI-RADS score ≥3 on CT and MR images. The ease, safety, and simplicity of preoperative embolization under local anesthesia make this procedure an option for patients at a high bleeding risk.

The Korean Society of Thoracic Radiology (KSTR) conducted an assessment on the necessity of low-dose chest CT (LDCT) lung cancer screening for Korean school cafeteria workers. This assessment was prompted by growing concerns about the potential risk of lung cancer due to exposure to carcinogenic cooking fumes. To reach a consensus on various aspects of LDCT screening for Korean school cafeteria workers, thoracic radiologists were involved in a survey that utilized the Delphi method. Key issues addressed in the survey included the need for tailored environmental assessments for this specific group, guidelines for interpreting LDCT results, and the evaluation of cooking occupations as a potential risk factor for lung cancer. The survey results revealed a lack of evidence supporting the benefits of LDCT lung cancer screening for Korean school cafeteria workers. Furthermore, there was no consensus reached on the criteria for determining which Korean school cafeteria workers should undergo LDCT screening, guidelines for interpreting the results, or the level of evidence supporting cooking tasks as a risk factor for lung cancer. In this position paper, the KSTR critically examines these aspects and emphasizes the importance of an evidence-based approach to lung cancer screening by considering the unique occupational and environmental context of Korean school cafeteria workers.

Radioembolization is a relatively safe procedure, and most adverse effects are part of the post-embolization syndrome, which includes symptoms such as abdominal pain and fatigue. Although serious complications are rare, when they do occur, they can significantly impact patient outcomes, potentially requiring long-term treatment or even causing death. Therefore, it is essential to thoroughly understand and prevent potential adverse events proactively. This review aimed to classify the complications associated with radioembolization into three categories: 1) complications due to local effects, such as radioembolization-induced liver disease and biliary injury, 2) complications due to nontarget radioembolization, such as gastrointestinal ulcers and radiation pneumonitis, and 3) complications due to systemic reactions; moreover, we herein describe the causes, symptoms, preventive strategies, and treatments for each type of adverse event.