Orlando Catalano, Roberta Fusco, Serena Carriero, Stefania Tamburrini, Vincenza Granata
External beam radiation therapy (RT) can induce toxicity in patients surgically treated for breast cancer. Modern irradiation techniques have lowered the incidence and severity of radiation-induced injuries; however, their side effects on normal tissues remain challenging. This review illustrates early and late changes observed using ultrasound (US) imaging, including echocardiography, at the skin, muscle, pleura, lungs, and heart levels. The US findings and the potential role of this technique in detecting and grading early and late complications of RT are highlighted in this article. US has proven useful in the differential diagnosis of post-RT complications, including but not limited to cancer recurrence and toxicity from other sources, such as anticancer drugs. Additionally, considering the progressive nature of RT-induced injury, early detection of toxicity may be helpful in the individual stratification of damage risk and serve as a tool for patient screening and management. In these cases, US can be used as a radiation-free biomarker of RT side effects at the subclinical stage.
{"title":"Ultrasound Findings After Breast Cancer Radiation Therapy: Cutaneous, Pleural, Pulmonary, and Cardiac Changes.","authors":"Orlando Catalano, Roberta Fusco, Serena Carriero, Stefania Tamburrini, Vincenza Granata","doi":"10.3348/kjr.2024.0672","DOIUrl":"10.3348/kjr.2024.0672","url":null,"abstract":"<p><p>External beam radiation therapy (RT) can induce toxicity in patients surgically treated for breast cancer. Modern irradiation techniques have lowered the incidence and severity of radiation-induced injuries; however, their side effects on normal tissues remain challenging. This review illustrates early and late changes observed using ultrasound (US) imaging, including echocardiography, at the skin, muscle, pleura, lungs, and heart levels. The US findings and the potential role of this technique in detecting and grading early and late complications of RT are highlighted in this article. US has proven useful in the differential diagnosis of post-RT complications, including but not limited to cancer recurrence and toxicity from other sources, such as anticancer drugs. Additionally, considering the progressive nature of RT-induced injury, early detection of toxicity may be helpful in the individual stratification of damage risk and serve as a tool for patient screening and management. In these cases, US can be used as a radiation-free biomarker of RT side effects at the subclinical stage.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 11","pages":"982-991"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Duration of Response as Clinical Endpoint: A Quick Guide for Clinical Researchers.","authors":"Seonok Kim, Min-Ju Kim, Jooae Choe","doi":"10.3348/kjr.2024.0589","DOIUrl":"10.3348/kjr.2024.0589","url":null,"abstract":"","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 11","pages":"937-941"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Generative artificial intelligence (AI) has been applied to images for image quality enhancement, domain transfer, and augmentation of training data for AI modeling in various medical fields. Image-generative AI can produce large amounts of unannotated imaging data, which facilitates multiple downstream deep-learning tasks. However, their evaluation methods and clinical utility have not been thoroughly reviewed. This article summarizes commonly used generative adversarial networks and diffusion models. In addition, it summarizes their utility in clinical tasks in the field of radiology, such as direct image utilization, lesion detection, segmentation, and diagnosis. This article aims to guide readers regarding radiology practice and research using image-generative AI by 1) reviewing basic theories of image-generative AI, 2) discussing the methods used to evaluate the generated images, 3) outlining the clinical and research utility of generated images, and 4) discussing the issue of hallucinations.
{"title":"Image-Based Generative Artificial Intelligence in Radiology: Comprehensive Updates.","authors":"Ha Kyung Jung, Kiduk Kim, Ji Eun Park, Namkug Kim","doi":"10.3348/kjr.2024.0392","DOIUrl":"10.3348/kjr.2024.0392","url":null,"abstract":"<p><p>Generative artificial intelligence (AI) has been applied to images for image quality enhancement, domain transfer, and augmentation of training data for AI modeling in various medical fields. Image-generative AI can produce large amounts of unannotated imaging data, which facilitates multiple downstream deep-learning tasks. However, their evaluation methods and clinical utility have not been thoroughly reviewed. This article summarizes commonly used generative adversarial networks and diffusion models. In addition, it summarizes their utility in clinical tasks in the field of radiology, such as direct image utilization, lesion detection, segmentation, and diagnosis. This article aims to guide readers regarding radiology practice and research using image-generative AI by 1) reviewing basic theories of image-generative AI, 2) discussing the methods used to evaluate the generated images, 3) outlining the clinical and research utility of generated images, and 4) discussing the issue of hallucinations.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 11","pages":"959-981"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the role of dynamic contrast-enhanced (DCE)-MRI of the extraocular muscles (EOMs) for determining the activity of thyroid-associated ophthalmopathy (TAO) and treatment response to glucocorticoids (GCs).
Materials and methods: We prospectively enrolled 65 patients with TAO (41 active, 82 eyes; 24 inactive, 48 eyes). Twenty-two active patients completed the GC treatment and follow-up assessment, including 15 patients (30 eyes) and 7 patients (14 eyes), defined as responsive and unresponsive, respectively. Model-free (time to peak [TTP], area under the curve [AUC], and Slopemax) and model-based (Ktrans, Kep, and Ve) parameters of EOMs in embedded simplified histogram analyses were calculated and compared between groups. Multivariable logistic regression analysis was used to identify the independent predictors. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance.
Results: Active patients exhibited significantly higher TTP at the 10th percentile (-10th), TTP-mean, and TTP at the 90th percentile (-90th); AUC-10th, AUC-mean, AUC-90th, and AUC-max; Ktrans-10th and Ktrans-mean; and Ve-10th, Ve-mean, Ve-90th, and Ve-max than inactive patients (P < 0.05). Responsive patients exhibited significantly lower TTP-min; higher Ktrans-mean and Ktrans-max; and higher Kep-10th, Kep-mean, and Kep-max than unresponsive patients (P < 0.05). TTP-mean and Ve-mean were independent variables for determining disease activity (P = 0.017 and 0.022, respectively). A combination of the two parameters could determine active TAO with moderate performance (AUROC = 0.687). TTP-min and Ktrans-mean were independent predictors of the response to GCs (P = 0.023 and 0.004, respectively), uniting which could determine the response to GCs with decent performance (AUROC = 0.821).
Conclusion: DCE-MRI-derived model-free and model-based parameters of EOMs can assist in the evaluation of TAO. In particular, TTP-mean and Ve-mean could be useful for determining the activity of TAO, whereas TTP-min and Ktrans-mean could be promising biomarkers for determining the response to GCs.
{"title":"Determining Disease Activity and Glucocorticoid Response in Thyroid-Associated Ophthalmopathy: Preliminary Study Using Dynamic Contrast-Enhanced MRI.","authors":"Hao Hu, Xiong-Ying Pu, Jiang Zhou, Wen-Hao Jiang, Qian Wu, Jin-Ling Lu, Fei-Yun Wu, Huan-Huan Chen, Xiao-Quan Xu","doi":"10.3348/kjr.2024.0335","DOIUrl":"10.3348/kjr.2024.0335","url":null,"abstract":"<p><strong>Objective: </strong>To assess the role of dynamic contrast-enhanced (DCE)-MRI of the extraocular muscles (EOMs) for determining the activity of thyroid-associated ophthalmopathy (TAO) and treatment response to glucocorticoids (GCs).</p><p><strong>Materials and methods: </strong>We prospectively enrolled 65 patients with TAO (41 active, 82 eyes; 24 inactive, 48 eyes). Twenty-two active patients completed the GC treatment and follow-up assessment, including 15 patients (30 eyes) and 7 patients (14 eyes), defined as responsive and unresponsive, respectively. Model-free (time to peak [TTP], area under the curve [AUC], and Slope<sub>max</sub>) and model-based (K<sup>trans</sup>, K<sub>ep</sub>, and V<sub>e</sub>) parameters of EOMs in embedded simplified histogram analyses were calculated and compared between groups. Multivariable logistic regression analysis was used to identify the independent predictors. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance.</p><p><strong>Results: </strong>Active patients exhibited significantly higher TTP at the 10th percentile (-10th), TTP-mean, and TTP at the 90th percentile (-90th); AUC-10th, AUC-mean, AUC-90th, and AUC-max; K<sup>trans</sup>-10th and K<sup>trans</sup>-mean; and V<sub>e</sub>-10th, V<sub>e</sub>-mean, V<sub>e</sub>-90th, and V<sub>e</sub>-max than inactive patients (<i>P</i> < 0.05). Responsive patients exhibited significantly lower TTP-min; higher K<sup>trans</sup>-mean and K<sup>trans</sup>-max; and higher K<sub>ep</sub>-10th, K<sub>ep</sub>-mean, and K<sub>ep</sub>-max than unresponsive patients (<i>P</i> < 0.05). TTP-mean and V<sub>e</sub>-mean were independent variables for determining disease activity (<i>P</i> = 0.017 and 0.022, respectively). A combination of the two parameters could determine active TAO with moderate performance (AUROC = 0.687). TTP-min and K<sup>trans</sup>-mean were independent predictors of the response to GCs (<i>P</i> = 0.023 and 0.004, respectively), uniting which could determine the response to GCs with decent performance (AUROC = 0.821).</p><p><strong>Conclusion: </strong>DCE-MRI-derived model-free and model-based parameters of EOMs can assist in the evaluation of TAO. In particular, TTP-mean and V<sub>e</sub>-mean could be useful for determining the activity of TAO, whereas TTP-min and K<sup>trans</sup>-mean could be promising biomarkers for determining the response to GCs.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sungmin Woo, Hebert Alberto Vargas, Anwar R Padhani
{"title":"Prostate Cancer Screening With MRI: Lessons Learned From Repeat Rounds of the GÖTEBORG-2 and STHLM3-MRI Trials.","authors":"Sungmin Woo, Hebert Alberto Vargas, Anwar R Padhani","doi":"10.3348/kjr.2024.1024","DOIUrl":"10.3348/kjr.2024.1024","url":null,"abstract":"","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo Hwa Choi, Soohee Kang, Nariya Cho, Soo-Yeon Kim
Objective: To develop a nomogram that integrates clinical-pathologic and imaging variables to predict ipsilateral breast tumor recurrence (IBTR) in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS).
Materials and methods: This retrospective study included consecutive women with DCIS who underwent BCS at two hospitals. Patients who underwent BCS between 2003 and 2016 in one hospital and between 2005 and 2013 in another were classified into development and validation cohorts, respectively. Twelve clinical-pathologic variables (age, family history, initial presentation, nuclear grade, necrosis, margin width, number of excisions, DCIS size, estrogen receptor, progesterone receptor, radiation therapy, and endocrine therapy) and six mammography and ultrasound variables (breast density, detection modality, mammography and ultrasound patterns, morphology and distribution of calcifications) were analyzed. A nomogram for predicting 10-year IBTR probabilities was constructed using the variables associated with IBTR identified from the Cox proportional hazard regression analysis in the development cohort. The performance of the developed nomogram was evaluated in the external validation cohort using a calibration plot and 10-year area under the receiver operating characteristic curve (AUROC) and compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram.
Results: The development cohort included 702 women (median age [interquartile range], 50 [44-56] years), of whom 30 (4%) women experienced IBTR. The validation cohort included 182 women (48 [43-54] years), 18 (10%) of whom developed IBTR. A nomogram was constructed using three clinical-pathologic variables (age, margin, and use of adjuvant radiation therapy) and two mammographic variables (breast density and calcification morphology). The nomogram was appropriately calibrated and demonstrated a comparable 10-year AUROC to the MSKCC nomogram (0.73 vs. 0.66, P = 0.534) in the validation cohort.
Conclusion: Our nomogram provided individualized risk estimates for women with DCIS treated with BCS, demonstrating a discriminative ability comparable to that of the MSKCC nomogram.
{"title":"A Nomogram Using Imaging Features to Predict Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ.","authors":"Bo Hwa Choi, Soohee Kang, Nariya Cho, Soo-Yeon Kim","doi":"10.3348/kjr.2024.0268","DOIUrl":"10.3348/kjr.2024.0268","url":null,"abstract":"<p><strong>Objective: </strong>To develop a nomogram that integrates clinical-pathologic and imaging variables to predict ipsilateral breast tumor recurrence (IBTR) in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS).</p><p><strong>Materials and methods: </strong>This retrospective study included consecutive women with DCIS who underwent BCS at two hospitals. Patients who underwent BCS between 2003 and 2016 in one hospital and between 2005 and 2013 in another were classified into development and validation cohorts, respectively. Twelve clinical-pathologic variables (age, family history, initial presentation, nuclear grade, necrosis, margin width, number of excisions, DCIS size, estrogen receptor, progesterone receptor, radiation therapy, and endocrine therapy) and six mammography and ultrasound variables (breast density, detection modality, mammography and ultrasound patterns, morphology and distribution of calcifications) were analyzed. A nomogram for predicting 10-year IBTR probabilities was constructed using the variables associated with IBTR identified from the Cox proportional hazard regression analysis in the development cohort. The performance of the developed nomogram was evaluated in the external validation cohort using a calibration plot and 10-year area under the receiver operating characteristic curve (AUROC) and compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram.</p><p><strong>Results: </strong>The development cohort included 702 women (median age [interquartile range], 50 [44-56] years), of whom 30 (4%) women experienced IBTR. The validation cohort included 182 women (48 [43-54] years), 18 (10%) of whom developed IBTR. A nomogram was constructed using three clinical-pathologic variables (age, margin, and use of adjuvant radiation therapy) and two mammographic variables (breast density and calcification morphology). The nomogram was appropriately calibrated and demonstrated a comparable 10-year AUROC to the MSKCC nomogram (0.73 vs. 0.66, <i>P</i> = 0.534) in the validation cohort.</p><p><strong>Conclusion: </strong>Our nomogram provided individualized risk estimates for women with DCIS treated with BCS, demonstrating a discriminative ability comparable to that of the MSKCC nomogram.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 10","pages":"876-886"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO).
Materials and methods: SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation.
Results: Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (P < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (P < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (P < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC: 0.925 vs. 0.779; P = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (r = 0.391, P < 0.001) and FOCUS MUSE DWI (r = 0.645, P < 0.001).
Conclusion: FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.
{"title":"Prospective Comparison of FOCUS MUSE and Single-Shot Echo-Planar Imaging for Diffusion-Weighted Imaging in Evaluating Thyroid-Associated Ophthalmopathy.","authors":"YunMeng Wang, YuanYuan Cui, JianKun Dai, ShuangShuang Ni, TianRan Zhang, Xin Chen, QinLing Jiang, YuXin Cheng, YiChuan Ma, Tuo Li, Yi Xiao","doi":"10.3348/kjr.2024.0177","DOIUrl":"10.3348/kjr.2024.0177","url":null,"abstract":"<p><strong>Objective: </strong>To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO).</p><p><strong>Materials and methods: </strong>SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation.</p><p><strong>Results: </strong>Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (<i>P</i> < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (<i>P</i> < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (<i>P</i> < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC: 0.925 vs. 0.779; <i>P</i> = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (<i>r</i> = 0.391, <i>P</i> < 0.001) and FOCUS MUSE DWI (<i>r</i> = 0.645, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 10","pages":"913-923"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration.
Materials and methods: This retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared.
Results: The intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs (P ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone (P < 0.048). Malignancy was not found in the very low risk category of USC RSS.
Conclusion: The diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.
研究目的本研究旨在评估基于超声(US)RSS、结节大小和细胞学亚类的综合风险分层系统(RSS)在诊断细针穿刺初步确定为Bethesda III类甲状腺结节的恶性肿瘤方面的性能:这项回顾性研究在两家医疗机构进行,包括贝塞斯达III类结节的连续患者,最终诊断结果由重复活检或手术证实。研究共纳入了 309 名患者(女性 223 人,男性 86 人;平均年龄(50.9±12.0)岁)的 320 个 Bethesda III 类结节(≥1 厘米)。根据 US RSS、结节大小和细胞学亚类评估了 Bethesda III 类结节的恶性风险和恶性预测因素。比较了US-size细胞学(USC)RSS和单独US RSS对恶性肿瘤的诊断效果:结果:在所有 US RSS 中,中度或高度怀疑 US 类别会独立增加恶性肿瘤风险(P ≤ 0.001)。大结节尺寸(≥3 厘米)可独立增加低度或中度可疑 US 类别结节的恶性风险。此外,在大多数 US RSS 中,意义未定的细胞学不典型性亚类会独立增加低度可疑 US 类别结节的恶性风险。USC RSS 的接收器操作特征曲线下面积大于单独 US RSS 的接收器操作特征曲线下面积(P < 0.048)。在 USC RSS 的极低风险类别中未发现恶性肿瘤:结论:在贝塞斯达 III 类结节中,USC RSS 对恶性肿瘤的诊断效果优于单纯 US RSS。在 USC RSS 的极低风险类别中可以排除恶性肿瘤。
{"title":"Risk Stratification of Thyroid Nodules Diagnosed as Bethesda Category III by Ultrasound, Size, and Cytology.","authors":"Hye Shin Ahn, Dong Gyu Na, Ji-Hoon Kim","doi":"10.3348/kjr.2024.0292","DOIUrl":"10.3348/kjr.2024.0292","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration.</p><p><strong>Materials and methods: </strong>This retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared.</p><p><strong>Results: </strong>The intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs (<i>P</i> ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone (<i>P</i> < 0.048). Malignancy was not found in the very low risk category of USC RSS.</p><p><strong>Conclusion: </strong>The diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.</p>","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 10","pages":"924-933"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"<i>KJR</i> Honors Distinguished Reviewers for 2024.","authors":"Seong Ho Park","doi":"10.3348/kjr.2024.0802","DOIUrl":"https://doi.org/10.3348/kjr.2024.0802","url":null,"abstract":"","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 10","pages":"874-875"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor \"Survey on Value Elements Provided by Artificial Intelligence and Their Eligibility for Insurance Coverage With an Emphasis on Patient-Centered Outcomes\".","authors":"Mukesh Kumar Dharmalingam Jothinathan","doi":"10.3348/kjr.2024.0727","DOIUrl":"10.3348/kjr.2024.0727","url":null,"abstract":"","PeriodicalId":17881,"journal":{"name":"Korean Journal of Radiology","volume":"25 10","pages":"934-935"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}