Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

Objective: For an accurate dynamic contrast-enhanced (DCE) MRI analysis, exact baseline T1 mapping is critical. The purpose of this study was to compare the pharmacokinetic parameters of DCE MRI using synthetic MRI with those using fixed baseline T1 values. Materials and Methods: This retrospective study included 102 patients who underwent both DCE and synthetic brain MRI. Two methods were set for the baseline T1: one using the fixed value and the other using the T1 map from synthetic MRI. The volume transfer constant (Ktrans ), volume of the vascular plasma space (vp), and the volume of the extravascular extracellular space (ve) were compared between the two methods. The interclass correlation coefficients and the Bland-Altman method were used to assess the reliability. Results: In normal-appearing frontal white matter (WM), the mean values of Ktrans , ve, and vp were significantly higher in the fixed value method than in the T1 map method. In the normal-appearing occipital WM, the mean values of ve and vp were significantly higher in the fixed value method. In the putamen and head of the caudate nucleus, the mean values of Ktrans , ve, and vp were significantly lower in the fixed value method. In addition, the T1 map method showed comparable interobserver agreements with the fixed baseline T1 value method. Conclusion The T1 map method using synthetic MRI may be useful for reflecting individual differences and reliable measurements in clinical applications of DCE MRI.

Objective: For an accurate dynamic contrast-enhanced (DCE) MRI analysis, exact baseline T1 mapping is critical. The purpose of this study was to compare the pharmacokinetic parameters of DCE MRI using synthetic MRI with those using fixed baseline T1 values. Materials and Methods: This retrospective study included 102 patients who underwent both DCE and synthetic brain MRI. Two methods were set for the baseline T1: one using the fixed value and the other using the T1 map from synthetic MRI. The volume transfer constant (Ktrans ), volume of the vascular plasma space (vp), and the volume of the extravascular extracellular space (ve) were compared between the two methods. The interclass correlation coefficients and the Bland-Altman method were used to assess the reliability. Results: In normal-appearing frontal white matter (WM), the mean values of Ktrans , ve, and vp were significantly higher in the fixed value method than in the T1 map method. In the normal-appearing occipital WM, the mean values of ve and vp were significantly higher in the fixed value method. In the putamen and head of the caudate nucleus, the mean values of Ktrans , ve, and vp were significantly lower in the fixed value method. In addition, the T1 map method showed comparable interobserver agreements with the fixed baseline T1 value method. Conclusion The T1 map method using synthetic MRI may be useful for reflecting individual differences and reliable measurements in clinical applications of DCE MRI.

Objective: To evaluate the association of MRI features with the major genomic profiles and prognosis of World Health Organization grade III (G3) gliomas compared with those of glioblastomas (GBMs). Materials and Methods: We enrolled 76 G3 glioma and 155 GBM patients with pathologically confirmed disease who had pretreatment brain MRI and major genetic information of tumors. Qualitative and quantitative imaging features, including volumetrics and histogram parameters, such as normalized cerebral blood volume (nCBV), cerebral blood flow (nCBF), and apparent diffusion coefficient (nADC) were evaluated. The G3 gliomas were divided into three groups for the analysis: with this isocitrate dehydrogenase (IDH)-mutation, IDH mutation and a chromosome arm 1p/19q-codeleted (IDHmut1p/19qdel), IDH mutation, 1p/19q-nondeleted (IDHmut1p/19qnondel), and IDH wildtype (IDHwt). A prediction model for the genetic profiles of G3 gliomas was developed and validated on a separate cohort. Both the quantitative and qualitative imaging parameters and progression-free survival (PFS) of G3 gliomas were compared and survival analysis was performed. Moreover, the imaging parameters and PFS between IDHwt G3 gliomas and GBMs were compared. Results: IDHmut G3 gliomas showed a larger volume (p = 0.017), lower nCBF (p = 0.048), and higher nADC (p = 0.007) than IDHwt. Between the IDHmut tumors, IDHmut1p/19qdel G3 gliomas had higher nCBV (p = 0.024) and lower nADC (p = 0.002) than IDHmut1p/19qnondel G3 gliomas. Moreover, IDHmut1p/19qdel tumors had the best prognosis and IDHwt tumors had the worst prognosis among G3 gliomas (p < 0.001). PFS was significantly associated with the 95th percentile values of nCBV and nCBF in G3 gliomas. There was no significant difference in neither PFS nor imaging features between IDHwt G3 gliomas and IDHwt GBMs. Conclusion We found significant differences in MRI features, including volumetrics, CBV, and ADC, in G3 gliomas, according to IDH mutation and 1p/19q codeletion status, which can be utilized for the prediction of genomic profiles and the prognosis of G3 glioma patients. The MRI signatures and prognosis of IDHwt G3 gliomas tend to follow those of IDHwt GBMs.

BACKGROUND AND OBJECTIVES: The association between hearing impairment and cognitive function has been established in previous studies. The aim of this study was to compare the effects of conventional hearing aids and middle ear implants on cognitive function. SUBJECTS AND METHOD: This study included 22 participants who underwent middle ear implantation between October 2013 and September 2016. Their mean age at surgery was 70 years. Using Pure tone audiometry (PTA), the Speech discrimination test (SDT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, we compared audiologic benefits of three conditions [without hearing aids, with conventional hearing aids, or with Vibrant Sound bridge (VSB)]. Cognitive ability was evaluated using neuropsychological testings (Seoul Neuropsychological Screening Battery) at intervals of approximately eight weeks. RESULTS: The results of PTA showed a 7.96 dB HL gain with conventional hearing aids and a 10.00 dB HL gain with the use of VSB. SDT results showed a 4.10% gain with conventional hearing aids and a 10% gain with the use of VSB. Results of the APHAB questionnaire showed a significant increase with the use of VSB compared to conventional hearing aids. In the Korean Mini-Mental State Examination, a slight improvement was observed after middle ear implantation. In the Digit Span Test and Korean-Boston Naming Test, a significant improvement was seen with the use of VSB compared to conventional hearing aids. CONCLUSION: The use of middle ear implants in rehabilitation of hearing communication in patients showed improvements in cognitive abilities, compared to the use of conventional hearing aids.
Audiometry ; Cognition* ; Ear, Middle* ; Hearing Aids* ; Hearing Loss ; Hearing* ; Humans ; Mass Screening ; Methods ; Neuropsychological Tests ; Ossicular Prosthesis* ; Rehabilitation ; Speech Discrimination Tests

BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Age Distribution ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; Male ; Medical Records ; Postpartum Thyroiditis ; Recurrence ; Retrospective Studies ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Subacute* ; Thyrotoxicosis ; Thyrotropin

BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Age Distribution ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; Male ; Medical Records ; Postpartum Thyroiditis ; Recurrence ; Retrospective Studies ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Subacute* ; Thyrotoxicosis ; Thyrotropin

Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 +/- 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients.
Adult ; Aged ; Diabetes Complications ; Female ; Hospitalization ; Humans ; Interleukin-6/blood ; Kidney Failure, Chronic/blood/*mortality ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; *Renal Dialysis ; Resistin/*blood ; Survival Analysis

BACKGROUND AND OBJECTIVES: Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopidogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. SUBJECTS AND METHODS: Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and completed >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment formulation, Platless(R) (test formulation, n=211) or Plavix(R) (reference formulation, n=217). The incidence of 1-year major adverse cardiovascular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. RESULTS: The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The incidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless(R) group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix(R) group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless(R) group vs. 0% in Plavix(R) group (p=0.49). CONCLUSION: In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective randomized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopidogrel.
Blood Platelets ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Incidence ; Myocardial Infarction ; Retrospective Studies ; Stents ; Stroke ; Tablets ; Thrombosis ; Ticlopidine

Accurate measurement of the volume status in hemodialysis patients is important as it can affect mortality. However, no studies have been conducted regarding volume management in cases where a sudden change of body fluid occurs, such as during puerperium in hemodialysis patients. This report presents a case in which the patient was monitored for her body composition and her volume status was controlled using a body composition monitor (BCM) during the puerperal period. This case suggests that using a BCM for volume management may help maintain hemodynamic stability in patients with a rapidly changing volume status for a short term period, such as during puerperium.
Body Composition ; Body Fluids ; Hemodynamics ; Humans ; Organothiophosphorus Compounds ; Postpartum Period ; Renal Dialysis