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16 "Magnetic resonance imaging"
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Original Articles
Lung and Thoracic cancer
Enhancing Identification of High-Risk cN0 Lung Adenocarcinoma Patients Using MRI-Based Radiomic Features
Harim Kim, Jonghoon Kim, Soohyun Hwang, You Jin Oh, Joong Hyun Ahn, Min-Ji Kim, Tae Hee Hong, Sung Goo Park, Joon Young Choi, Hong Kwan Kim, Jhingook Kim, Sumin Shin, Ho Yun Lee
Cancer Res Treat. 2025;57(1):57-69.   Published online June 26, 2024
DOI: https://doi.org/10.4143/crt.2024.251
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to develop a magnetic resonance imaging (MRI)–based radiomics model to predict high-risk pathologic features for lung adenocarcinoma: micropapillary and solid pattern (MPsol), spread through air space, and poorly differentiated patterns.
Materials and Methods
As a prospective study, we screened clinical N0 lung cancer patients who were surgical candidates and had undergone both 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) and chest CT from August 2018 to January 2020. We recruited patients meeting our proposed imaging criteria indicating high-risk, that is, poorer prognosis of lung adenocarcinoma, using CT and FDG PET/CT. If possible, these patients underwent an MRI examination from which we extracted 77 radiomics features from T1-contrast-enhanced and T2-weighted images. Additionally, patient demographics, maximum standardized uptake value on FDG PET/CT, and the mean apparent diffusion coefficient value on diffusion-weighted image, were considered together to build prediction models for high-risk pathologic features.
Results
Among 616 patients, 72 patients met the imaging criteria for high-risk lung cancer and underwent lung MRI. The magnetic resonance (MR)–eligible group showed a higher prevalence of nodal upstaging (29.2% vs. 4.2%, p < 0.001), vascular invasion (6.5% vs. 2.1%, p=0.011), high-grade pathologic features (p < 0.001), worse 4-year disease-free survival (p < 0.001) compared with non-MR-eligible group. The prediction power for MR-based radiomics model predicting high-risk pathologic features was good, with mean area under the receiver operating curve (AUC) value measuring 0.751-0.886 in test sets. Adding clinical variables increased the predictive performance for MPsol and the poorly differentiated pattern using the 2021 grading system (AUC, 0.860 and 0.907, respectively).
Conclusion
Our imaging criteria can effectively screen high-risk lung cancer patients and predict high-risk pathologic features by our MR-based prediction model using radiomics.
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Gastrointestinal cancer
Intraindividual Comparison of MRIs with Extracellular and Hepatobiliary Contrast Agents for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using the Korean Liver Cancer Association–National Cancer Center 2022 Criteria
Ja Kyung Yoon, Dai Hoon Han, Sunyoung Lee, Jin-Young Choi, Gi Hong Choi, Do Young Kim, Myeong-Jin Kim
Cancer Res Treat. 2023;55(3):939-947.   Published online February 10, 2023
DOI: https://doi.org/10.4143/crt.2022.1645
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The aim of the present study was to evaluate the per-lesion sensitivity and specificity of the Korean Liver Cancer Association–National Cancer Center (KLCA-NCC) 2022 criteria for the noninvasive diagnosis of hepatocellular carcinoma (HCC), with intraindividual comparison of the diagnostic performance of magnetic resonance imaging with extracellular agents (ECA-MRI) and hepatobiliary agents (HBA-MRI).
Materials and Methods
Patients at high risk for HCC who were referred to a tertiary academic institution for hepatic lesions with size ≥ 10 mm between July 2019 and June 2022 were enrolled. A total of 91 patients (mean age, 58.1 years; 76 men and 15 women) with 118 lesions who underwent both ECA-MRI and HBA-MRI were eligible for final analysis. The per-lesion sensitivities and specificities of the KLCA-NCC 2022 criteria using ECA-MRI and HBA-MRI were compared using McNemar’s test.
Results
The 118 lesions were 93 HCCs, 4 non-HCC malignancies, and 21 benign lesions. On HBA-MRI, the “definite” HCC category showed significantly higher sensitivity than ECA-MRI (78.5% vs. 58.1%, p < 0.001), with identical specificity (92.0% vs. 92.0%, p > 0.999). For “probable” or “definite” HCC categories, there were no differences in the sensitivity (84.9% vs. 84.9%, p > 0.999) and specificity (84.0% vs. 84.0%, p > 0.999) between ECA-MRI and HBA-MRI.
Conclusion
The “definite” HCC category of the KLCA-NCC 2022 criteria showed higher sensitivity in diagnosing HCC on HBA-MRI compared with ECA-MRI, without compromising specificity. There were no significant differences in the sensitivity and specificity of “probable” or “definite” HCC categories according to ECA-MRI and HBA-MRI.

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  • Intraindividual comparison of prognostic imaging features of HCCs between MRIs with extracellular and hepatobiliary contrast agents
    Ja Kyung Yoon, Dai Hoon Han, Sunyoung Lee, Jin‐Young Choi, Gi Hong Choi, Do Young Kim, Myeong‐Jin Kim
    Liver International.2024; 44(10): 2847.     CrossRef
  • 3,795 View
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  • 1 Web of Science
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Genitourinary cancer
Prediction of Pathologic Findings with MRI-Based Clinical Staging Using the Bayesian Network Modeling in Prostate Cancer: A Radiation Oncologist Perspective
Chan Woo Wee, Bum-Sup Jang, Jin Ho Kim, Chang Wook Jeong, Cheol Kwak, Hyun Hoe Kim, Ja Hyeon Ku, Seung Hyup Kim, Jeong Yeon Cho, Sang Youn Kim
Cancer Res Treat. 2022;54(1):234-244.   Published online May 17, 2021
DOI: https://doi.org/10.4143/crt.2020.1221
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b).
Materials and Methods
A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation.
Results
According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p < 0.001), percentage of positive biopsy cores (PPC) (β=0.033, p < 0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p < 0.001), and cTMRI (β=0.259, p < 0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p < 0.001), PPC (β=0.024, p < 0.001), Gleason score (β=0.753, p < 0.001), and cTMRI (β=0.507, p < 0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall area under the receiver operating characteristic curve (AUC)/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74, p=0.060) and SVI (0.88 vs. 0.84, p < 0.001).
Conclusion
Two models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.

Citations

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  • Measurements of target volumes and organs at risk using DW‑MRI in patients with central lung cancer accompanied with atelectasis
    Xinli Zhang, Tong Liu, Hong Zhang, Mingbin Zhang
    Molecular and Clinical Oncology.2023;[Epub]     CrossRef
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  • 144 Download
  • 1 Web of Science
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Genitourinary Cancer
A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population
Tae Il Noh, Chang Wan Hyun, Ha Eun Kang, Hyun Jung Jin, Jong Hyun Tae, Ji Sung Shim, Sung Gu Kang, Deuk Jae Sung, Jun Cheon, Jeong Gu Lee, Seok Ho Kang
Cancer Res Treat. 2021;53(4):1148-1155.   Published online December 31, 2020
DOI: https://doi.org/10.4143/crt.2020.1068
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters.
Materials and Methods
We retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [Gleason score ≥ 3+4]) and compared by analyzing the areas under the curves and decision curves.
Results
A predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed.
Conclusion
This predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.

Citations

Citations to this article as recorded by  
  • Abbreviated MRI Protocols in the Abdomen and Pelvis
    Kristina I. Ringe, Jin Wang, Ying Deng, Shan Pi, Amine Geahchan, Bachir Taouli, Mustafa R. Bashir
    Journal of Magnetic Resonance Imaging.2024; 59(1): 58.     CrossRef
  • Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer
    Arya Haj-Mirzaian, Kristine S. Burk, Ronilda Lacson, Daniel I. Glazer, Sanjay Saini, Adam S. Kibel, Ramin Khorasani
    JAMA Network Open.2024; 7(3): e244258.     CrossRef
  • The Barcelona Predictive Model of Clinically Significant Prostate Cancer
    Juan Morote, Angel Borque-Fernando, Marina Triquell, Anna Celma, Lucas Regis, Manel Escobar, Richard Mast, Inés M. de Torres, María E. Semidey, José M. Abascal, Carles Sola, Pol Servian, Daniel Salvador, Anna Santamaría, Jacques Planas, Luis M. Esteban, E
    Cancers.2022; 14(6): 1589.     CrossRef
  • Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study
    Tae Il Noh, Ji Sung Shim, Sung Gu Kang, Jun Cheon, Jeong Gu Lee, Seok Ho Kang
    Sexual Medicine.2022; 10(3): 1.     CrossRef
  • Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy
    Juan Morote, Angel Borque-Fernando, Marina Triquell, Anna Celma, Lucas Regis, Richard Mast, Inés M. de Torres, María E. Semidey, José M. Abascal, Pol Servian, Anna Santamaría, Jacques Planas, Luis M. Esteban, Enrique Trilla
    Cancers.2022; 14(10): 2374.     CrossRef
  • Magnetic Resonance Imaging-Based Predictive Models for Clinically Significant Prostate Cancer: A Systematic Review
    Marina Triquell, Miriam Campistol, Ana Celma, Lucas Regis, Mercè Cuadras, Jacques Planas, Enrique Trilla, Juan Morote
    Cancers.2022; 14(19): 4747.     CrossRef
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Diagnostic Accuracy and Value of Magnetic Resonance Imaging–Ultrasound Fusion Transperineal Targeted and Template Systematic Prostate Biopsy Based on Bi-parametric Magnetic Resonance Imaging
Tae Il Noh, Jong Hyun Tae, Hyung Keun Kim, Ji Sung Shim, Sung Gu Kang, Deuk Jae Sung, Jun Cheon, Jeong Gu Lee, Seok Ho Kang
Cancer Res Treat. 2020;52(3):714-721.   Published online February 10, 2020
DOI: https://doi.org/10.4143/crt.2019.716
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)–ultrasound (US) fusion transperineal targeted biopsy (FTB) and fusion template systematic biopsy (FSB) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) (intermediate/high grade [Gleason score ≥ 3+4]) based on bi-parametric MRI (bpMRI).
Materials and methods
Retrospectively, we analyzed 300 patients with elevated prostate-specific antigen (≥ 4.0 ng/mL) and/or abnormal findings in a digital rectal examination at the Korea University Hospital. All 300 men underwent bpMRI-US fusion transperineal FTB and FSB in the period from April 2017 to March 2019.
Results
PCas were detected in 158 of 300 men (52.7%), and the prevalence of csPCa was 34.0%. CsPCas were detected in 12 of 102 (11.8%) with Prostate Imaging-Reporting and Data System (PI-RADS) 3, 42 of 92 (45.7%) with PI-RADS 4, respectively; and 45 of 62 (72.6%) men with PI-RADS 5, respectively. BpMRI showed a sensitivity of 95.1% and negative predictive value of 89.6% for csPCa. FTB detected additional csPCa in 33 men (12.9%) compared to FSB. Compared to FTB, FSB detected additional csPCa in 10 men (3.9%).
Conclusion
BpMRI-US FTB and FSB improved detection of PCa and csPCa. The accuracy of bi-parametric MRI is comparable with that of multi-parametric MRI. Further, it is rapid, simpler, cheaper, and no side effects of contrast media. Therefore, it is expected that bpMRI-US transperineal FTB and FSB could be a good alternative to conventional US-guided transrectal biopsy, which is the current gold standard.

Citations

Citations to this article as recorded by  
  • Diagnostic performance of transperineal prostate targeted biopsy alone according to the PI-RADS score based on bi-parametric magnetic resonance imaging
    Tae Il Noh, Ji Sung Shim, Seok Ho Kang, Jun Cheon, Sung Gu Kang
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study
    Tae Il Noh, Ji Sung Shim, Sung Gu Kang, Jun Cheon, Jeong Gu Lee, Seok Ho Kang
    Sexual Medicine.2022; 10(3): 1.     CrossRef
  • Concordance between biparametric MRI, transperineal targeted plus systematic MRI-ultrasound fusion prostate biopsy, and radical prostatectomy pathology
    Tae Il Noh, Ji Sung Shim, Sung Gu Kang, Jun Cheon, Jeong Gu Lee, Jeong Hyeon Lee, Seok Ho Kang
    Scientific Reports.2022;[Epub]     CrossRef
  • Three-dimensional ultrasound integrating nomogram and the blood flow image for prostate cancer diagnosis and biopsy: A retrospective study
    Dong Chen, Yingjie Niu, Haitao Chen, Dequan Liu, Rong Guo, Nan Yao, Zhiyao Li, Xiaomao Luo, Hongyang Li, Shicong Tang
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Comparison between biparametric and multiparametric MRI in predicting muscle invasion by bladder cancer based on the VI-RADS
    Tae Il Noh, Ji Sung Shim, Sung Gu Kang, Deuk Jae Sung, Jun Cheon, Ki Choon Sim, Seok Ho Kang
    Scientific Reports.2022;[Epub]     CrossRef
  • A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population
    Tae Il Noh, Chang Wan Hyun, Ha Eun Kang, Hyun Jung Jin, Jong Hyun Tae, Ji Sung Shim, Sung Gu Kang, Deuk Jae Sung, Jun Cheon, Jeong Gu Lee, Seok Ho Kang
    Cancer Research and Treatment.2021; 53(4): 1148.     CrossRef
  • PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer
    Vlad Cristian Munteanu, Raluca Andrada Munteanu, Diana Gulei, Vlad Horia Schitcu, Bogdan Petrut, Ioana Berindan Neagoe, Patriciu Achimas Cadariu, Ioan Coman
    Diagnostics.2020; 10(10): 806.     CrossRef
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  • 169 Download
  • 10 Web of Science
  • 7 Crossref
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Interim Tumor Progression and Volumetric Changes of Surgical Cavities during the Surgery-to-Radiotherapy Interval in Anaplastic Gliomas: Implications for Additional Pre-radiotherapy Magnetic Resonance Imaging
Chan Woo Wee, Il Han Kim, Chul-Kee Park, Jin Wook Kim
Cancer Res Treat. 2020;52(2):524-529.   Published online October 31, 2019
DOI: https://doi.org/10.4143/crt.2019.520
AbstractAbstract PDFPubReaderePub
Purpose
This study was designed to investigate the incidence of interim disease progression (IPD) and volumetric changes of the surgical cavity (SC) during the surgery-to-radiotherapy interval (SRI), and eventually assess the value of magnetic resonance imaging (MRI) at the time of radiotherapy (RT) planning in newly diagnosed anaplastic gliomas.
Materials and Methods
Among 195 anaplastic glioma patients who underwent RT, 121 were evaluable with two separate MRIs during SRI. The presence of IPD was determined using the updated Response Assessment in Neuro-Oncology size criteria. In 84 patients who underwent surgical resection, each SC was contoured by a radiation oncologist and the volumetric changes of the SCs were calculated between the two separate MRIs. Daily rate of change in the SC volume was calculated assuming an exponential and linear change.
Results
Five of 121 patients (4.13%) demonstrated IPD during SRI, and the incidence was significantly higher in patients undergoing biopsy (vs. surgical resection, 12.9% vs. 1.1%, p=0.015) and in patients with remnant contrast-enhancing tumor after surgery (15.8 vs. 2.0%, p=0.027). The mean daily rate of absolute change in SC was 1.06% (95% confidence interval [CI], 0.89 to 1.23) and 0.89% (95% CI, 0.77 to 1.02) according to the exponential and linear model, respectively. The expected mean volumetric change at 2 weeks were 16.64% (95% CI, 13.77 to 19.52) and 12.51% (95% CI, 10.77 to 14.26), respectively.
Conclusion
IPD during the SRI is rare in surgically resected anaplastic gliomas. However, pre-RT MRI is essential for accurate RT-target delineation and disease evaluation for patients initiating RT beyond postoperative 2 weeks and undergoing biopsy, respectively.

Citations

Citations to this article as recorded by  
  • Types of deviation and review criteria in pretreatment central quality control of tumor bed boost in medulloblastoma—an analysis of the German Radiotherapy Quality Control Panel in the SIOP PNET5 MB trial
    Stefan Dietzsch, Annett Braesigk, Clemens Seidel, Julia Remmele, Ralf Kitzing, Tina Schlender, Martin Mynarek, Dirk Geismar, Karolina Jablonska, Rudolf Schwarz, Montserrat Pazos, Damien C. Weber, Silke Frick, Kristin Gurtner, Christiane Matuschek, Semi Be
    Strahlentherapie und Onkologie.2022; 198(3): 282.     CrossRef
  • Effect of 3D Slicer Preoperative Planning and Intraoperative Guidance with Mobile Phone Virtual Reality Technology on Brain Glioma Surgery
    Jun Liu, Xiaodong Li, Xueping Leng, Bo Zhong, Yanhong Liu, Liang Liu, Mohammad Farukh Hashmi
    Contrast Media & Molecular Imaging.2022;[Epub]     CrossRef
  • 5,482 View
  • 165 Download
  • 2 Web of Science
  • 2 Crossref
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Carcinoembryonic Antigen Improves the Performance of Magnetic Resonance Imaging in the Prediction of Pathologic Response after Neoadjuvant Chemoradiation for Patients with Rectal Cancer
Gyu Sang Yoo, Hee Chul Park, Jeong Il Yu, Doo Ho Choi, Won Kyung Cho, Young Suk Park, Joon Oh Park, Ho Yeong Lim, Won Ki Kang, Woo Yong Lee, Hee Cheol Kim, Seong Hyeon Yun, Yong Beom Cho, Yoon Ah Park, Kyoung Doo Song, Seok-Hyung Kim, Sang Yun Ha
Cancer Res Treat. 2020;52(2):446-454.   Published online September 25, 2019
DOI: https://doi.org/10.4143/crt.2019.261
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer.
Materials and Methods
We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT.
Results
The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI.
Conclusion
The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.

Citations

Citations to this article as recorded by  
  • Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement
    Jeong Ha Lee, Nalee Kim, Jeong Il Yu, Gyu Sang Yoo, Hee Chul Park, Woo-Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin, Joon Oh Park, Seung Tae Kim, Young Suk Park, Jeeyun Lee, Won Ki Kang
    Radiation Oncology Journal.2024; 42(2): 130.     CrossRef
  • Predicting the response to neoadjuvant chemoradiation for rectal cancer using nomograms based on MRI tumour regression grade
    S. Qin, Y. Chen, K. Liu, Y. Li, Y. Zhou, W. Zhao, P. Xin, Q. Wang, S. Lu, H. Wang, N. Lang
    Cancer/Radiothérapie.2024; 28(4): 341.     CrossRef
  • Body composition parameters combined with blood biomarkers and magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
    Jianguo Yang, Qican Deng, Zhenzhou Chen, Yajun Chen, Zhongxue Fu
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Pretreatment blood biomarkers combined with magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
    Xinyu Shi, Min Zhao, Bo Shi, Guoliang Chen, Huihui Yao, Junjie Chen, Daiwei Wan, Wen Gu, Songbing He
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Clinical implication and management of rectal cancer with clinically suspicious lateral pelvic lymph node metastasis: A radiation oncologist’s perspective
    Gyu Sang Yoo, Hee Chul Park, Jeong Il Yu
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • High-Resolution T2-Weighted MRI to Evaluate Rectal Cancer: Why Variations Matter
    Kirsten L Gormly
    Korean Journal of Radiology.2021; 22(9): 1475.     CrossRef
  • MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology
    Seong Ho Park, Seung Hyun Cho, Sang Hyun Choi, Jong Keon Jang, Min Ju Kim, Seung Ho Kim, Joon Seok Lim, Sung Kyoung Moon, Ji Hoon Park, Nieun Seo
    Korean Journal of Radiology.2020; 21(7): 812.     CrossRef
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  • 182 Download
  • 7 Web of Science
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Magnetic Resonance-Based Texture Analysis Differentiating KRAS Mutation Status in Rectal Cancer
Ji Eun Oh, Min Ju Kim, Joohyung Lee, Bo Yun Hur, Bun Kim, Dae Yong Kim, Ji Yeon Baek, Hee Jin Chang, Sung Chan Park, Jae Hwan Oh, Sun Ah Cho, Dae Kyung Sohn
Cancer Res Treat. 2020;52(1):51-59.   Published online May 7, 2019
DOI: https://doi.org/10.4143/crt.2019.050
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Mutation of the Kirsten Ras (KRAS) oncogene is present in 30%-40% of colorectal cancers and has prognostic significance in rectal cancer. In this study, we examined the ability of radiomics features extracted from T2-weighted magnetic resonance (MR) images to differentiate between tumors with mutant KRAS and wild-type KRAS.
Materials and Methods
Sixty patients with primary rectal cancer (25 with mutant KRAS, 35 with wild-type KRAS) were retrospectively enrolled. Texture analysis was performed in all regions of interest on MR images, which were manually segmented by two independent radiologists. We identified potentially useful imaging features using the two-tailed t test and used them to build a discriminant model with a decision tree to estimate whether KRAS mutation had occurred.
Results
Three radiomic features were significantly associated with KRASmutational status (p < 0.05). The mean (and standard deviation) skewness with gradient filter value was significantly higher in the mutant KRAS group than in the wild-type group (2.04±0.94 vs. 1.59±0.69). Higher standard deviations for medium texture (SSF3 and SSF4) were able to differentiate mutant KRAS (139.81±44.19 and 267.12±89.75, respectively) and wild-type KRAS (114.55±29.30 and 224.78±62.20). The final decision tree comprised three decision nodes and four terminal nodes, two of which designated KRAS mutation. The sensitivity, specificity, and accuracy of the decision tree was 84%, 80%, and 81.7%, respectively.
Conclusion
Using MR-based texture analysis, we identified three imaging features that could differentiate mutant from wild-type KRAS. T2-weighted images could be used to predict KRAS mutation status preoperatively in patients with rectal cancer.

Citations

Citations to this article as recorded by  
  • A multicenter study: predicting KRAS mutation and prognosis in colorectal cancer through a CT-based radiomics nomogram
    Manman Li, Yiwen Yuan, Hui Zhou, Feng Feng, Guodong Xu
    Abdominal Radiology.2024; 49(6): 1816.     CrossRef
  • SG-Transunet: A segmentation-guided Transformer U-Net model for KRAS gene mutation status identification in colorectal cancer
    Yulan Ma, Yuzhu Guo, Weigang Cui, Jingyu Liu, Yang Li, Yingsen Wang, Yan Qiang
    Computers in Biology and Medicine.2024; 173: 108293.     CrossRef
  • CHNet: A multi-task global–local Collaborative Hybrid Network for KRAS mutation status prediction in colorectal cancer
    Meiling Cai, Lin Zhao, Yan Qiang, Long Wang, Juanjuan Zhao
    Artificial Intelligence in Medicine.2024; 155: 102931.     CrossRef
  • Assessment of prognostic indicators and KRAS mutations in rectal cancer using a fractional-order calculus MR diffusion model: whole tumor histogram analysis
    Mi Zhou, Hongyun Huang, Deying Bao, Meining Chen, Fulin Lu
    Abdominal Radiology.2024;[Epub]     CrossRef
  • The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer
    Sebastian Curcean, Andra Curcean, Daniela Martin, Zsolt Fekete, Alexandru Irimie, Alina-Simona Muntean, Cosmin Caraiani
    Cancers.2024; 16(17): 3111.     CrossRef
  • A segmentation-based sequence residual attention model for KRAS gene mutation status prediction in colorectal cancer
    Lin Zhao, Kai Song, Yulan Ma, Meiling Cai, Yan Qiang, Jingyu Sun, Juanjuan Zhao
    Applied Intelligence.2023; 53(9): 10232.     CrossRef
  • Rectal MRI Interpretation After Neoadjuvant Therapy
    Natally Horvat, Maria El Homsi, Joao Miranda, Yousef Mazaheri, Marc J. Gollub, Viktoriya Paroder
    Journal of Magnetic Resonance Imaging.2023; 57(2): 353.     CrossRef
  • Association between Dynamic Contrast-Enhanced MRI Parameters and Prognostic Factors in Patients with Primary Rectal Cancer
    Hye Ri Kim, Seung Ho Kim, Kyung Han Nam
    Current Oncology.2023; 30(2): 2543.     CrossRef
  • Virtual biopsy in abdominal pathology: where do we stand?
    Arianna Defeudis, Jovana Panic, Giulia Nicoletti, Simone Mazzetti, Valentina Giannini, Daniele Regge
    BJR|Open.2023;[Epub]     CrossRef
  • Repeatability of radiomics studies in colorectal cancer: a systematic review
    Ying Liu, Xiaoqin Wei, Xu Feng, Yan Liu, Guiling Feng, Yong Du
    BMC Gastroenterology.2023;[Epub]     CrossRef
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Impact of Mucin Proportion in the Pretreatment MRI on the Outcomes of Rectal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy
Eunji Kim, Kyubo Kim, Se Hyung Kim, Sae-Won Han, Tae-You Kim, Seung-Yong Jeong, Kyu Joo Park, Jaemoon Koh, Gyeong Hoon Kang, Eui Kyu Chie
Cancer Res Treat. 2019;51(3):1188-1197.   Published online December 20, 2018
DOI: https://doi.org/10.4143/crt.2018.434
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to evaluate treatment response to neoadjuvant chemoradiotherapy (CRT) with regard to mucin status in pathology and pretreatment magnetic resonance imaging (MRI) in locally advanced rectal cancer.
Materials and Methods
Between 2003 and 2011, 306 patients with locally advanced rectal cancer received neoadjuvant CRT followed by surgery, and mucinous adenocarcinoma (MAC) was found in 27 (8.8%). All MAC patients had MRI before and after CRT and mucin proportion at MRI was measured. Therapeutic response was assessed by pathology after total mesorectal excision. To determine the optimal cut-off for mucin proportion in predicting good CRT response (near total or total regression) and negative circumferential resection margin (CRM), the receiver-operating characteristic analysis was performed.
Results
After neoadjuvant CRT, overall downstaging occurred in 44.4% of MAC and 72.4% of non-MAC (p=0.001), and positive CRM (≤1 mm) was observed more frequently in MAC (p<0.001). The optimal threshold for treatment response was 30% for mucin proportion, and there are nine with low mucin proportion (<30%) and 18 with high mucin proportion (≥30%) in pretreatment MRI. Negative CRM and tumor downstaging occurred more common in patients with mucin <30%, although statistically insignificant (p=0.071 and p=0.072, respectively). Regarding oncologic outcomes, lower mucin proportion in pretreatment MRI was associated with better disease-free and overall survival in MAC group (p=0.092 and 0.056, respectively), but the difference did not reach statistical significance.
Conclusion
Poor treatment outcome with neoadjuvant CRT was observed in patients with MAC, especially those with high mucin proportion at pretreatment MRI.

Citations

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  • Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma
    Xiangwen Tan, Yiwei Zhang, Xiaofeng Wu, Qing Fang, Yunhua Xu, Shuxiang Li, Jinyi Yuan, Xiuda Peng, Kai Fu, Shuai Xiao
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Incremental Role of Pancreatic Magnetic Resonance Imaging after Staging Computed Tomography to Evaluate Patients with Pancreatic Ductal Adenocarcinoma
Hye Jin Kim, Mi-Suk Park, Jin Yong Lee, Kyunghwa Han, Yong Eun Chung, Jin-Young Choi, Myeong-Jin Kim, Chang Moo Kang
Cancer Res Treat. 2019;51(1):24-33.   Published online February 5, 2018
DOI: https://doi.org/10.4143/crt.2017.404
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the impact of contrast enhanced pancreatic magnetic resonance imaging (MRI) in resectability and prognosis evaluation after staging computed tomography (CT) in patients with pancreatic ductal adenocarcinoma (PDA).
Materials and Methods
From January 2005 to December 2012, 298 patients were diagnosed to have potentially resectable stage PDA on CT. Patients were divided into CT+MR (patients underwent both CT and MRI; n=216) and CT only groups (n=82). Changes in resectability staging in the CT+MR group were evaluated. The overall survival was compared between the two groups. The recurrence-free survival and median time to liver metastasis after curative surgery were compared between the two groups.
Results
Staging was changed from resectable on CT to unresectable state on MRI in 14.4% of (31 of 216 patients) patients of the CT+MR group. The overall survival and recurrence-free survival rates were not significantly different between the two groups (p=0.162 and p=0.721, respectively). The median time to liver metastases after curative surgery in the CT+MR group (9.9 months) was significantly longer than that in the CT group (4.2 months) (p=0.011).
Conclusion
Additional MRI resulted in changes of resectability and treatment modifications in a significant proportion of patients who have potentially resectable state at CT and in prolonged time to liver metastases in patients after curative surgery. Additional MRI to standard staging CT can be recommended for surgical candidates of PDA.

Citations

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Magnetic Resonance Imaging for Colorectal Cancer Metastasis to the Liver: Comparative Effectiveness Research for the Choice of Contrast Agents
Nieun Seo, Mi-Suk Park, Kyunghwa Han, Kyung Ho Lee, Seong Ho Park, Gi Hong Choi, Jin-Young Choi, Yong Eun Chung, Myeong-Jin Kim
Cancer Res Treat. 2018;50(1):60-70.   Published online March 14, 2017
DOI: https://doi.org/10.4143/crt.2016.533
AbstractAbstract PDFPubReaderePub
Purpose
This study was conducted to compare the diagnostic performance and early recurrence rate between gadoxetic acid–enhanced magnetic resonance imaging (Gd-EOB-MRI) and magnetic resonance imaging (MRI) with extracellular contrast agent (ECA-MRI) for evaluating hepatic lesions in colorectal cancer.
Materials and Methods
Between 2005 and 2010, 418 colorectal cancer patients with both preoperative computed tomography (CT) and liver MRI were retrospectively reviewed. Image analysis was based on initial radiologic reports, and diagnostic performance was assessed based on the area under the receiver operating characteristic curve (AUROC). The early intrahepatic recurrence rate within 6 months was then evaluated.
Results
Overall, 291 and 127 patients underwent Gd-EOB-MRI and ECA-MRI, respectively. The AUROCs were not significantly different between Gd-EOB-MRI (0.990; 95% CI, 0.980 to 0.999) and ECA-MRI (0.985; 95% CI, 0.968 to 1.000; p=0.836). When compared with CT alone, ECA-MRI detected additional 21 lesions in 14 patients (14/127, 11.0%), whereas Gd-EOB-MRI detected 56 lesions in 33 patients (33/291, 11.3%) without a significant difference between two MRI groups (p=0.331). The early recurrence rate in the ECA-MRI (28.6%) was significantly higher than that in the Gd-EOB-MRI (11.6%) for patients who underwent hepatic resection (p=0.031).
Conclusion
Gd-EOB-MRI is potentially better than ECA-MRI for decreasing the early intrahepatic recurrence rate, although the two MRI modalities showed comparable diagnostic performance in colorectal cancer patients.

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Magnetic Resonance Imaging–Detected Intracranial Extension in the T4 Classification Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy
Caineng Cao, Jingwei Luo, Li Gao, Junlin Yi, Xiaodong Huang, Suyan Li, Jianping Xiao, Zhong Zhang, Guozhen Xu
Cancer Res Treat. 2017;49(2):518-525.   Published online August 24, 2016
DOI: https://doi.org/10.4143/crt.2016.299
AbstractAbstract PDFPubReaderePub
Purpose
This study was conducted is to identify the prognostic value and staging categories of magnetic resonance imaging (MRI)–detected intracranial extension in nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) to determine whether it is necessary to subclassify the T4 classification NPC.
Materials and Methods
A total of 335 nonmetastatic T4 classificationNPC patientswith MRI treated between March 2004 and June 2011 by radical IMRTwere included. The T4 classification patientswere subclassified into two grades (T4a, without intracranial extension vs. T4b, with intracranial extension) according to the site of invasion.
Results
The frequency of intracranial extensionwas 40.9% (137 of 335 patients). Multivariate analysis identified subclassification (T4a vs. T4b) as an independent prognostic factor for local failure-free survival (p=0.049; hazard ratio [HR], 0.498) and overall survival (p=0.004; HR, 0.572); however, it had no effect on regional failure-free survival or distant failure-free survival (p > 0.050).
Conclusion
For patients with T4 classification NPC, those with MRI-detected intracranial extension are more likely to experience local failure and death afterIMRT than patientswithout intracranial extension. According to the site of invasion, subclassification of T4 patients as T4a or T4b has prognostic value in NPC.

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Dynamic Contrast-Enhanced Magnetic Resonance Imaging as a Surrogate Biomarker for Bevacizumab in Colorectal Cancer Liver Metastasis: A Single-Arm, Exploratory Trial
Yeo-Eun Kim, Bio Joo, Mi-Suk Park, Sang Joon Shin, Joong Bae Ahn, Myeong-Jin Kim
Cancer Res Treat. 2016;48(4):1210-1221.   Published online March 17, 2016
DOI: https://doi.org/10.4143/crt.2015.374
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to investigate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plasma cytokines and angiogenic factors (CAFs) as pharmacodynamic and prognostic biomarkers of bevacizumab monotherapy in colorectal cancer with liver metastasis (CRCLM). Materials and Methods From July 2011 to March 2012, 28 patients with histologically confirmed CRCLM received bevacizumab monotherapy followed by combined FOLFOX therapy. The mean age of the patients was 57 years (range, 30 to 77 years). DCE-MRI (Ktransand IAUC60) was performed at baseline, first follow-up (3 days after bevacizumab monotherapy), and second follow-up (3 days after combined therapy). CAF levels (vascular endothelial growth factor [VEGF], placental growth factor [PlGF], and interleukin-8) were assessed on the same days. Progression-free survival (PFS) time distributions were summarized using the Kaplan-Meier method and compared using log-rank tests.
Results
The median PFS period was 11.2 months. Ktrans, IAUC60, VEGF, and PlGF values on the first follow-up day were significantly different compared with baseline values. No differences were observed on the second follow-up day. A > 40% decrease in Ktrans from baseline to first follow-up was associated with a longer PFS (hazard ratio, 0.349; 95% confidence interval, 0.133 to 0.912; p=0.032). Changes in CAFs did not show correlation with PFS time. Conclusion DCE-MRI parameters and CAFs are pharmacodynamic biomarkers of bevacizumab for CRCLM. In our study, change in Ktrans at 3 days after bevacizumab monotherapy was a favorable prognostic factor; however, the value of CAFs as a prognostic biomarker was not found.

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Diagnostic and Prognostic Implications of Spine Magnetic Resonance Imaging at Diagnosis in Patients with Multiple Myeloma
Ik-Chan Song, Ji-Na Kim, Yoon-Seok Choi, Haewon Ryu, Myung-Won Lee, Hyo-Jin Lee, Hwan-Jung Yun, Samyong Kim, Soon Tae Kwon, Deog-Yeon Jo
Cancer Res Treat. 2015;47(3):465-472.   Published online November 3, 2014
DOI: https://doi.org/10.4143/crt.2014.010
AbstractAbstract PDFPubReaderePub
Purpose
The aim of this study is to determine the diagnostic and prognostic role of baseline spinal magnetic resonance imaging (MRI) in patients with multiple myeloma.
Materials and Methods
We enrolled patients newly diagnosed with multiple myeloma from 2004-2011 at a single center. Abnormal MRI findings that were not detected in radiographs have been analyzed and categorized as malignant compression fractures or extramedullary plasmacytoma. The bone marrow (BM) infiltration patterns on MRI have been classified into five categories.
Results
A total of 113 patients with a median age of 65 years (range, 40 to 89 years) were enrolled in the study. Malignant compression fractures not detected in the bone survey were found in 26 patients (23.0%), including three patients (2.6%) with no related symptoms or signs. Extramedullary plasmacytoma was detected in 22 patients (19.5%), including 15 (13.3%) with epidural extension of the tumor. Of these 22 patients, 11 (50.0%) had no relevant symptoms or signs. The presence of malignant compression fractures did not influence overall survival; whereas non-epidural extramedullary plasmacytoma was associated with poor overall survival in the multivariate analysis (hazard ratio, 3.205; 95% confidence interval [CI], 1.430 to 9.845; p=0.042). During the follow-up for a median of 21 months (range, 1 to 91 months), overall survival with the mixed BM infiltrative pattern (median, 24.0 months; 95% CI, 22.9 to 25.1 months) was shorter than those with other patterns (median 56 months; 95% CI, 48.9 to 63.1 months; p=0.030).
Conclusion
These results indicate that spine MRI at the time of diagnosis is useful for detecting skeletal lesions and predicting the prognosis in patients with multiple myeloma.

Citations

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    Uday Yanamandra, Arun Kumar Reddy Gorla, Kanhaiyalal Agrawal, Bhagwant Rai Mittal, Gaurav Prakash, Alka Rani Khadwal, Neelam Varma, Subhash Varma, Pankaj Malhotra
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    Jung Min Lee, Hee Jeong Cho, Joon-Ho Moon, Sang Kyun Sohn, Byunggeon Park, Dong Won Baek
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    Marius Horger, Hendrick Ditt, Shu Liao, Katja Weisel, Jan Fritz, Wolfgang M. Thaiss, Sascha Kaufmann, Konstantin Nikolaou, Christopher Kloth
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    Abhishek R Keraliya, Katherine M Krajewski, Jyothi P Jagannathan, Atul B Shinagare, Marta Braschi-Amirfarzan, Sree H Tirumani, Nikhil H Ramaiya
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    Melissa Gaik-Ming Ooi, Sanjay de Mel, Wee Joo Chng
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Case Report
Calcified Carcinoma of the Gallbladder with Calcified Nodal Metastasis Presenting as a Porcelain Gallbladder: A Case Report
Eun Joo Yun, Dae Young Yoon, Chul Soon Choi, Sang Hoon Bae, Young Lan Seo, Suk Ki Chang, Kyoung Ja Lim, Jung Hye Kwon, Mi Jung Kwon, Eun Sook Nam
Cancer Res Treat. 2011;43(1):71-74.   Published online March 31, 2011
DOI: https://doi.org/10.4143/crt.2011.43.1.71
AbstractAbstract PDFPubReaderePub
Porcelain gallbladder is regarded as a risk factor of gallbladder cancer. A porcelain gallbladder with calcified regional lymph nodes was found using computed tomography (CT) and magnetic resonance imaging (MRI) in a 43-year-old man who presented with nausea, vomiting, and abdominal pain. His cholecystectomy specimen showed diffuse wall thickening and contained small gallstones. Histological examination revealed diffuse infiltrative adenocarcinoma with extensive intratumoral calcification (calcified carcinoma). The majority of the calcified material was located within or replaced the tumor glands, and was not found in the stroma. A lymph node was totally replaced with a calcified metastatic adenocarcinoma. To the best of our knowledge, only one case of calcified lymph node metastasis from a calcified carcinoma of the gallbladder has been previously reported in the literature. We herein add a case of calcified carcinoma of the gallbladder with calcified lymph node metastasis, presenting as a porcelain gallbladder on CT and MRI.

Citations

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  • A porcelain gallbladder and a rapid tumor dissemination
    Juan-Ramón Gómez-López, Beatriz De Andrés-Asenjo, Christian Ortega-Loubon
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    Thomas Schnelldorfer
    Journal of Gastrointestinal Surgery.2013; 17(6): 1161.     CrossRef
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Original Article
Assessment of Tumor Regression by Consecutive Pelvic Magnetic Resonance Imaging and Dose Modification during High-Dose-Rate Brachytherapy for Carcinoma of the Uterine Cervix
Taek-Keun Nam, Byung-Sik Nah, Ho-Sun Choi, Woong-Ki Chung, Sung-Ja Ahn, Seok-Mo Kim, Ju-Young Song, Mi-Seon Yoon
Cancer Res Treat. 2005;37(3):157-164.   Published online June 30, 2005
DOI: https://doi.org/10.4143/crt.2005.37.3.157
AbstractAbstract PDFPubReaderePub
Purpose

To assess tumor regression, as determined by pelvic magnetic resonance imaging (MRI), and evaluate the efficacies and toxicities of the interim brachytherapy (BT) modification method, according to tumor regression during multi-fractionated high-dose-rate (HDR) BT for uterine cervical cancer.

Materials and Methods

Consecutive MRI studies were performed pre-radiotherapy (RT), pre-BT and during interfraction of BT (inter-BT) in 69 patients with cervical cancer. External beam radiotherapy (EBRT) was performed, using a 10 MV X-ray, in daily fraction of 1.8 Gy with 4-fields, 5 d/wk. Radiation was delivered up to 50.4 Gy, with midline shielding at around 30.6 Gy. Of all 69 patients, 50 received modified interim BT after checking the inter-BT MRI. The BT was delivered in two sessions; the first was composed of several 5 Gy fractions to point A, twice weekly, using three channel applicators. According to the three measured orthogonal diameters of the regressed tumor, based on inter-BT MR images, the initial BT plan was modified, with the second session consisting of a few fractions of less than 5 Gy to point A, using a cervical cylinder applicator.

Results

The numbers of patients in FIGO stages Ib, IIa, IIb and IIIb+IVa were 19 (27.5%), 18 (26.1%), 27 (39.2%) and 5 (7.2%), respectively. Our treatment characteristics were comparable to those from the literatures with respect to the biologically effective dose (BED) to point A, rectum and bladder as reference points. In the regression analysis a significant correlation was observed between tumor regression and the cumulative dose to point A on the follow-up MRI. Nearly 80% regression of the initial tumor volume occurred after 30.6 Gy of EBRT, and this increased to 90% after an additional 25 Gy in 5 fractions of BT, which corresponds to 73.6 Gy of cumulative BED10 to point A. The median total fraction number, and those at the first and second sessions of BT were 8 (5~10), 5 (3~7) and 3 (1~5), respectively. The median follow-up time was 53 months (range, 9~66 months). The 4-year disease-free survival rate of all patients was 86.8%. Six (8.7%) patients developed pelvic failures, but major late complications developed in only two (2.9%).

Conclusion

Our study shows that effective tumor control, equivalent survival and low rates of major complications can be achieved by modifying the fraction size during BT according to tumor regression, as determined by consecutive MR images. We recommend checking the follow-up MRI at a cumulative BED10 of around 65 Gy to point A, with the initial BT modified at a final booster BT session.

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  • Correlations of UICC tumor stage and tumor regression on T2-weighted MRI sequences during definitive radiotherapy of cervical cancer
    Florian Arend, Markus Oechsner, Clara B. Weidenbächer, Stephanie E. Combs, Kai J. Borm, Marciana N. Duma
    Tumori Journal.2021; 107(2): 139.     CrossRef
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    Wenqing Sun, Sudershan K. Bhatia, Geraldine M. Jacobson, Ryan T. Flynn, Yusung Kim
    Practical Radiation Oncology.2012; 2(4): e101.     CrossRef
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    Mee Sun Yoon, Sung-Ja Ahn, Byung-Sik Nah, Woong-Ki Chung, Ho-Chun Song, Su Woong Yoo, Ju-Young Song, Jae-Uk Jeong, Taek-Keun Nam
    International Journal of Radiation Oncology*Biology*Physics.2012; 84(4): e491.     CrossRef
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