Although many imaging modalities can play some roles in the diagnosis of vertebral artery dissection (VAD), digital subtraction angiography (DSA) remains the gold standard method, with the highest detection rate and ability to assist in planning for endovascular treatment. However, this tool is often avoided in children because its invasive nature and it exposes them to radiation. High resolution magnetic resonance imaging (HR-MRI) have been suggested to be a reliable and non-invasive alternative, but it has never been discussed in children in whom vertebral artery dissection is a rare condition. In this report, we evaluate a case of a 2-year-old child who initially presented with cerebellar symptoms, and was early diagnosed with vertebral artery dissection using HR-MRI and was successfully treated.
Angiography, Digital Subtraction ; Child ; Child, Preschool ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Methods ; Vertebral Artery Dissection ; Vertebral Artery

Hepatocellular carcinoma (HCC) is a biologically heterogeneous tumor characterized by varying degrees of aggressiveness.The current treatment strategy for HCC is predominantly determined by the overall tumor burden, and does not address the diverse prognoses of patients with HCC owing to its heterogeneity. Therefore, the prognostication of HCC using imaging data is crucial for optimizing patient management. Although some radiologic features have been demonstrated to be indicative of the biologic behavior of HCC, traditional radiologic methods for HCC prognostication are based on visually-assessed prognostic findings, and are limited by subjectivity and inter-observer variability. Consequently, artificial intelligence has emerged as a promising method for image-based prognostication of HCC. Unlike traditional radiologic image analysis, artificial intelligence based on radiomics or deep learning utilizes numerous image-derived quantitative features, potentially offering an objective, detailed, and comprehensive analysis of the tumor phenotypes. Artificial intelligence, particularly radiomics has displayed potential in a variety of applications, including the prediction of microvascular invasion, recurrence risk after locoregional treatment, and response to systemic therapy. This review highlights the potential value of artificial intelligence in the prognostication of HCC as well as its limitations and future prospects.

Objective: This study aimed to investigate the impact of coronavirus disease-2019 (COVID-19) on suicide attempts and suicide deaths in South Korea, focusing on age and sex differences. Methods: We analyzed the monthly number of suicide attempts and suicide deaths during pre-pandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using nationally representative databases. We conducted an interrupted time series analysis and calculated the relative risk (RR) with a 95% confidence interval (CI), categorizing subjects into adolescents (<18), young adults (18–29), middle-aged (30–59), and older adults (≥60). Results: During the pandemic, the number of suicide attempts abruptly declined in adolescents (RR [95% CI] level change: 0.58 [0.45–0.75]) and older adults (RR [95% CI] level change: 0.74 [0.66–0.84]). In older males, there was a significant rebound in the suicide attempt trend (RR [95% CI] slope change: 1.03 [1.01–1.05]). The number of suicide deaths did not change among age/sex strata significantly except for older males. There was a brief decline in suicide deaths in older males, while the trend showed a following increase with marginal significance (RR [95% CI] level change: 0.76 [0.66–0.88], slope change: 1.02 [1.00–1.04]). Conclusion This study suggests the heterogeneous impact of the COVID-19 pandemic on suicide attempts and suicide deaths across age and sex strata in South Korea. These findings highlight the need for more targeted mental health interventions, given the observed trends in suicide attempts and suicide deaths during the pandemic.

Objective: This study aimed to investigate the impact of coronavirus disease-2019 (COVID-19) on suicide attempts and suicide deaths in South Korea, focusing on age and sex differences. Methods: We analyzed the monthly number of suicide attempts and suicide deaths during pre-pandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using nationally representative databases. We conducted an interrupted time series analysis and calculated the relative risk (RR) with a 95% confidence interval (CI), categorizing subjects into adolescents (<18), young adults (18–29), middle-aged (30–59), and older adults (≥60). Results: During the pandemic, the number of suicide attempts abruptly declined in adolescents (RR [95% CI] level change: 0.58 [0.45–0.75]) and older adults (RR [95% CI] level change: 0.74 [0.66–0.84]). In older males, there was a significant rebound in the suicide attempt trend (RR [95% CI] slope change: 1.03 [1.01–1.05]). The number of suicide deaths did not change among age/sex strata significantly except for older males. There was a brief decline in suicide deaths in older males, while the trend showed a following increase with marginal significance (RR [95% CI] level change: 0.76 [0.66–0.88], slope change: 1.02 [1.00–1.04]). Conclusion This study suggests the heterogeneous impact of the COVID-19 pandemic on suicide attempts and suicide deaths across age and sex strata in South Korea. These findings highlight the need for more targeted mental health interventions, given the observed trends in suicide attempts and suicide deaths during the pandemic.

Objective: This study aimed to investigate the impact of coronavirus disease-2019 (COVID-19) on suicide attempts and suicide deaths in South Korea, focusing on age and sex differences. Methods: We analyzed the monthly number of suicide attempts and suicide deaths during pre-pandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using nationally representative databases. We conducted an interrupted time series analysis and calculated the relative risk (RR) with a 95% confidence interval (CI), categorizing subjects into adolescents (<18), young adults (18–29), middle-aged (30–59), and older adults (≥60). Results: During the pandemic, the number of suicide attempts abruptly declined in adolescents (RR [95% CI] level change: 0.58 [0.45–0.75]) and older adults (RR [95% CI] level change: 0.74 [0.66–0.84]). In older males, there was a significant rebound in the suicide attempt trend (RR [95% CI] slope change: 1.03 [1.01–1.05]). The number of suicide deaths did not change among age/sex strata significantly except for older males. There was a brief decline in suicide deaths in older males, while the trend showed a following increase with marginal significance (RR [95% CI] level change: 0.76 [0.66–0.88], slope change: 1.02 [1.00–1.04]). Conclusion This study suggests the heterogeneous impact of the COVID-19 pandemic on suicide attempts and suicide deaths across age and sex strata in South Korea. These findings highlight the need for more targeted mental health interventions, given the observed trends in suicide attempts and suicide deaths during the pandemic.

Objective: This study aimed to investigate the impact of coronavirus disease-2019 (COVID-19) on suicide attempts and suicide deaths in South Korea, focusing on age and sex differences. Methods: We analyzed the monthly number of suicide attempts and suicide deaths during pre-pandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using nationally representative databases. We conducted an interrupted time series analysis and calculated the relative risk (RR) with a 95% confidence interval (CI), categorizing subjects into adolescents (<18), young adults (18–29), middle-aged (30–59), and older adults (≥60). Results: During the pandemic, the number of suicide attempts abruptly declined in adolescents (RR [95% CI] level change: 0.58 [0.45–0.75]) and older adults (RR [95% CI] level change: 0.74 [0.66–0.84]). In older males, there was a significant rebound in the suicide attempt trend (RR [95% CI] slope change: 1.03 [1.01–1.05]). The number of suicide deaths did not change among age/sex strata significantly except for older males. There was a brief decline in suicide deaths in older males, while the trend showed a following increase with marginal significance (RR [95% CI] level change: 0.76 [0.66–0.88], slope change: 1.02 [1.00–1.04]). Conclusion This study suggests the heterogeneous impact of the COVID-19 pandemic on suicide attempts and suicide deaths across age and sex strata in South Korea. These findings highlight the need for more targeted mental health interventions, given the observed trends in suicide attempts and suicide deaths during the pandemic.

Objective: We aimed to assess and validate the radiologic and clinical factors that were associated with recurrence and survival after curative surgery for heterogeneous targetoid primary liver malignancies in patients with chronic liver disease and to develop scoring systems for risk stratification. Materials and Methods: This multicenter retrospective study included 197 consecutive patients with chronic liver disease who had a single targetoid primary liver malignancy (142 hepatocellular carcinomas, 37 cholangiocarcinomas, 17 combined hepatocellular carcinoma-cholangiocarcinomas, and one neuroendocrine carcinoma) identified on preoperative gadoxetic acid-enhanced MRI and subsequently surgically removed between 2010 and 2017. Of these, 120 patients constituted the development cohort, and 77 patients from separate institution served as an external validation cohort. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were identified using a Cox proportional hazards analysis, and risk scores were developed. The discriminatory power of the risk scores in the external validation cohort was evaluated using the Harrell C-index. The Kaplan–Meier curves were used to estimate RFS and OS for the different risk-score groups. Results: In RFS model 1, which eliminated features exclusively accessible on the hepatobiliary phase (HBP), tumor size of 2–5 cm or > 5 cm, and thin-rim arterial phase hyperenhancement (APHE) were included. In RFS model 2, tumors with a size of > 5 cm, tumor in vein (TIV), and HBP hypointense nodules without APHE were included. The OS model included a tumor size of > 5 cm, thin-rim APHE, TIV, and tumor vascular involvement other than TIV. The risk scores of the models showed good discriminatory performance in the external validation set (C-index, 0.62–0.76). The scoring system categorized the patients into three risk groups: favorable, intermediate, and poor, each with a distinct survival outcome (all log-rank p < 0.05). Conclusion Risk scores based on rim arterial enhancement pattern, tumor size, HBP findings, and radiologic vascular invasion status may help predict postoperative RFS and OS in patients with targetoid primary liver malignancies.

Objective: Cine magnetic resonance imaging (MRI) has emerged as a noninvasive method to quantitatively assess bowel motility. However, its accuracy in measuring various degrees of small bowel motility has not been extensively evaluated. We aimed to draw a quantitative small bowel motility score from cine MRI and evaluate its performance in a population with varying degrees of small bowel motility. Materials and Methods: A total of 174 participants (28.5 ± 7.6 years; 135 males) underwent a 22-second-long cine MRI sequence (2-dimensional balanced turbo-field echo; 0.5 seconds per image) approximately 5 minutes after being intravenously administered 10 mg of scopolamine-N-butyl bromide to deliberately create diverse degrees of small bowel motility. In a manually segmented area of the small bowel, motility was automatically quantified using a nonrigid registration and calculated as a quantitative motility score. The mean value (MV) of motility grades visually assessed by two radiologists was used as a reference standard. The quantitative motility score’s correlation (Spearman’s ρ) with the reference standard and performance (area under the receiver operating characteristics curve [AUROC], sensitivity, and specificity) for diagnosing adynamic small bowel (MV of 1) were evaluated. Results: For the MV of the quantitative motility scores at grades 1, 1.5, 2, 2.5, and 3, the mean ± standard deviation values were 0.019 ± 0.003, 0.027 ± 0.010, 0.033 ± 0.008, 0.032 ± 0.009, and 0.043 ± 0.013, respectively. There was a significant positive correlation between the quantitative motility score and the MV (ρ = 0.531, P < 0.001). The AUROC value for diagnosing a MV of 1 (i.e., adynamic small bowel) was 0.953 (95% confidence interval, 0.923–0.984). Moreover, the optimal cutoff for the quantitative motility score was 0.024, with a sensitivity of 100% (15/15) and specificity of 89.9% (143/159). Conclusion The quantitative motility score calculated from a cine MRI enables diagnosis of an adynamic small bowel, and potentially discerns various degrees of bowel motility.

Objective: This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD). Materials and Methods: We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters. Results: Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11–117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81; p = 0.034) and LS-VR (sHR, 0.71; p = 0.01) were independently associated with hepatic decompensation. The ∆LS-VR (sHR, 0.54; p = 0.002) was predictive of hepatic decompensation after adjusting for baseline variables. ∆LS-VR was an independent predictor of liver-related death or transplantation in patients with compensated ACLD (sHR, 0.46; p = 0.026) and decompensated ACLD (sHR, 0.61; p = 0.023). Conclusion MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.