Eugene Lee

Background: We aimed to establish thresholds for assessing clinically meaningful pain improvement after spinal injections using numerical rating scale (NRS) and patient-reported relative reduction (PRR) of pain. Methods: This single-center retrospective study included 1,828 patients who received spinal injections at our spinal intervention center and completed a 2-week follow-up telephone interview in 2017. NRS absolute and relative reductions were calculated using the NRS scores before injection and at follow-up. The PRR and 5-point global perceived effect (GPE; 1, completely recovered; 2, much improved; 3, slightly improved; 4, no change; and 5, worsened) were recorded. The mean ± standard deviation (SD) of NRS absolute reduction, NRS relative reduction, and PRR in the GPE 2 and 3 subgroups were calculated. Receiver-operating-characteristic curve analysis was used to determine the cutoffs for NRS absolute and relative reduction and PRR in predicting the substantial clinically important difference (SCID, GPE 1–2) and minimal clinically important difference (MCID, GPE 1–3). Results: The mean ± SD of NRS absolute and relative reduction, and PRR in the GPE 2 and GPE 3 were 4.5 ± 1.8, 65.4% ± 21.1%, and 67.7% ± 14.8% and 2.4 ± 1.4, 36.8% ± 22.5%, and 35.7% ± 16.1%, respectively. The cutoffs for predicting SCID and MCID were NRS absolute reduction of ≥3 and ≥1, NRS relative reduction of ≥50% and ≥10%, and PRR of ≥50% and ≥20%, respectively. Conclusions: The NRS absolute and relative reduction and PRR thresholds were established to differentiate SCID and MCID in terms of pain improvement after spinal injections.

Little information is available regarding the factors that contribute to the occurrence of right innominate vein stenosis in patients with chemoports. Thus, the aims of this study were to evaluate the prevalence of chemoport-related right innominate vein stenosis (CR-RIVS) in patients with colorectal cancer and to identify factors associated with increased CR-RIVS risk. This retrospective study included patients with colorectal cancer (age, ≥ 19 years) who underwent their first chemoport insertion via the right internal jugular vein between August 2015 and August 2020. The prevalence of CR-RIVS was evaluated using follow-up contrast-enhanced chest computed tomography post-chemoport insertion. Risk factors were analyzed using Classification and Regression Tree, Kaplan-Meier survival, and Cox regression analyses. A subgroup analysis was also conducted among patients in palliative care to assess the impact of bevacizumab and cetuximab treatment on the prevalence of CR-RIVS. Among 1,442 patients with colorectal cancer (mean age, 62.1 ± 11.8 years; 850 males), the prevalence of CR-RIVS was 6.6%. The median time from chemoport insertion to CR-RIVS occurrence was 405 days (interquartile range, 256–908 days). The Classification and Regression Tree analysis identified palliative settings as the key predictor of CR-RIVS. Age, palliative settings, and a time×palliative setting interaction were identified as statistically significant variables ( p < 0.001). In the 728 palliative patients, bevacizumab treatment was significantly associated with a higher risk of CR-RIVS (hazard ratio = 1.51, 95% confidence interval: 1.25–1.82, P < 0.001), whereas cetuximab was not ( p = 0.85). The CR-RIVS-free probability was lower in patients receiving palliative chemotherapy than in those undergoing adjuvant chemotherapy ( p < 0.001); it was also lower in the bevacizumab-treated patients ( p < 0.001) in the palliative setting subgroup analysis. In summary, the prevalence of CR-RIVS was 6.6% in patients with colorectal cancer. Bevacizumab use showed the strongest association with CR-RIVS occurrence in the palliative subgroup analysis.

Background: Opportunistic screening of osteoporosis on CT has emerged as a cost-effective strategy for bone health assessment. However, vertebral attenuation varies substantially with CT tube voltage and spinal level, limiting standardization. Purpose: To model and standardize vertebral attenuation across tube voltages and spinal levels on low-dose chest CT for opportunistic osteoporosis screening. Materials and Methods: This retrospective study included 589 patients (336 women; mean age ± standard deviation, 65.9 ± 12.4 years) who underwent 2 noncontrast low-dose chest CT examinations and 1 dual-energy X-ray absorptiometry within 3 months. Vertebral attenuation was measured at T10–L2 on CT using a deep learning-based software (AVIEW SpineBH, Coreline Soft). Osteoporosis was diagnosed using dual-energy X-ray absorptiometry. A linear mixed-effects model regressed attenuation on the logarithm of tube voltage, incorporating fixed effects for spinal level (T10–L2) and patient-specific random effects. Model performance was evaluated by converting the L1–120 kVp reference to other tube-voltage–level combinations and comparing predicted with observed attenuation using Pearson correlation, mean bias, and 95% limits of agreement. Diagnostic applicability was assessed by comparing receiver operating characteristic–derived thresholds with model-predicted thresholds converted from the reference. Results: Vertebral attenuation decreased by approximately 6–11 Hounsfield units (HU) for every 10-kVp increase (β = −88.8 HU per log[kVp]; P < .001) and declined by approximately 4–14 HU per level from T10 to L2. Predicted values closely matched observed measurements (r = 0.89; mean bias, 2.2 HU; 95% limits of agreement, –54 to 59 HU). The model-predicted thresholds showed strong agreement with receiver operating characteristic–derived thresholds, differing by 1–10 HU across tube voltages and spinal levels. Conclusions: A log-linear mixed-effects model enables population-level standardization of vertebral attenuation across tube voltages and spinal levels, supporting the development of more consistent opportunistic CT-based osteoporosis screening methods on noncontrast chest CT.

A deep learning model trained using multimodal reference standards matched or exceeded human readers in lesion-level precision and recall and scan-level area under the receiver operating characteristic curve for detecting bone metastasis at CT.

To evaluate image quality of decubitus lumbar spine MRI using a flexible coil with or without Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction (PROPELLER) sequence compared to that of the conventional supine lumbar spine MRI. This study was conducted on patients who underwent decubitus lumbar spine MRI applying a flexible coil at a single center between February 1 and March 11, 2025, and had a Numeric Rating Scale (NRS) pain score ≥ 5, while examining supine MRI. Signal-to-noise ratio (SNR) in T2-weighted fast-spin-echo (FSE) sequence for supine, decubitus, and PROPELLER sequence at decubitus position were measured and compared using the Wilcoxon signed-rank test. Two radiologists independently evaluated the subjective image quality of each spine MRI. A total of 35 patients (mean age, 66 ± 13 years) were included in our study. On T2-weighted sagittal images, cerebrospinal fluid (CSF) SNR was highest in the supine_FSE (589.3, 95% CI: 482.1-695.1) and significantly lower in both decubitus_FSE (431.2, 95% CI: 365.9-479.9) and decubitus_PROPELLER (417.8, 95% CI: 389.2-439.1) (p < 0.001). On T2-weighted axial images, SNR_CSF values of supine_FSE (284.6, 95% CI: 256.4-331.0) and decubitus_PROPELLER (245.0, 95% CI: 215.7-336.1) were both statistically higher than that of decubitus_FSE (176.1, 95% CI: 135.9-209.2) (p < 0.001). In qualitative analysis, there was no statistical difference across supine_FSE, decubitus_FSE, and decubitus_PROPELLER. Image quality of decubitus lumbar spine MRI using a flexible coil was clinically feasible with acceptable image quality. PROPELLER sequence improved SNR_CSF on axial images in decubitus position.

Intracranial hypotension typically presents with orthostatic headache caused by cerebrospinal fluid (CSF) hypovolemia, most commonly resulting from spontaneous or iatrogenic CSF leaks. Traumatic rupture of an occult congenital sacral meningocele following a minor injury is exceptionally rare and may be diagnostically challenging. We report the case of a 40-year-old woman in Korea who developed sudden severe orthostatic headache immediately after a minor coccygeal contusion. Magnetic resonance myelography demonstrated a 5.8-cm dural ectasia/meningocele at the S3 level with a focal CSF fistula extending into the presacral space, accompanied by a tethered cord and an intradural lipoma. Given the anticipated risks associated with definitive surgical repair, a targeted trans-sacrococcygeal epidural blood patch was administered, resulting in substantial symptomatic improvement. This case highlights that while most post-traumatic CSF leaks occur at the cervical or thoracic level, occult spinal dysraphism should be considered a rare predisposing factor in post-traumatic orthostatic headache, particularly when trauma involves the sacrococcygeal region or when standard imaging findings are unrevealing. This finding also suggests that targeted caudal epidural blood patches may serve as a reasonable and less invasive treatment option when surgical intervention carries a high risk.

To evaluate the diagnostic utility of four preoperative MRI findings in identifying the location of dural defects associated with spinal extradural arachnoid cyst (SEAC) to optimize surgical planning. Fifteen patients with symptomatic SEAC who underwent surgery between 2003 and 2023 were analyzed retrospectively. The following preoperative MRI features were independently evaluated by two radiologists: the septation sign, extraforaminal extension with or without bone remodeling, the C-sign, and the flow-void sign. The accuracy of each finding in predicting the location of surgically confirmed dural defects was assessed. The septation sign was observed in all patients (100%), with the accuracy of predicting the location of the dural defect ranging from 80% to 87%. Extraforaminal extension was also identified in all patients, with a similar accuracy of (80%–87%). The C-sign and flow-void signs were less frequently observed (40%–47% and 47%–93%, respectively), with accuracies in predicting the dural defect location ranging from 71%–83% and 71%–79%, respectively. Inter-reader agreement was highest for the C-sign and flow-void sign (100%), followed by extraforaminal extension (93%) and the septation sign (80%). Recognition of MRI features—the septation sign, extraforaminal extension with or without bone remodeling, the C-sign, and the flow-void sign—may aid in localizing dural defects. These imaging markers may support surgical planning for SEAC.

Background: Opportunistic screening of osteoporosis using computed tomography (CT) should be optimized according to CT protocols. However, to date, no study has evaluated the different contrast phases of CT urography in osteoporosis screening. Purpose: To compare the diagnostic performance of different contrast phases of CT urography in opportunistic screening of osteoporosis. Material and Methods: In this single-center retrospective study, 210 consecutive patients (181 men, 29 women; mean age = 72.0 ± 9.5 years) who underwent both CT urography and dual-energy X-ray absorptiometry (DXA) within 3 months in July to December 2020 were included. The attenuation value was measured at the center of the L1 vertebral body in the axial plane of the precontrast, corticomedullary, and excretory phases. The mean and standard deviation (SD) of attenuation values were calculated. The area under the receiver operating characteristic curve (AUC) in differentiating osteoporosis versus osteopenia/normal was measured in each phase, and non-parametric comparisons between precontrast and the other phases were performed. Results: According to DXA results, 90, 90, and 30 patients were classified into the normal, osteopenia, and osteoporosis groups, respectively. The mean ± SD of attenuation values in the precontrast, corticomedullary, and excretory phases were 114.9 ± 47.8, 132.8 ± 49.3, and 126.2 ± 47.2 HU, respectively. A significant difference was observed between AUCs measured in the precontrast (0.804, 95% confidence interval [CI] = 0.717–0.890) and corticomedullary phases (0.760, 95% CI = 0.661–0.860) ( P = 0.003) and those between the precontrast and excretory phases (0.774, 95% CI = 0.678–0.869) ( P = 0.005). Conclusion: The precontrast phase outperformed the other phases in the opportunistic screening of osteoporosis using CT urography.

Background Neurosarcoidosis is rare, and among its manifestations, nerve root involvement has been reported in only a few cases. Therefore, magnetic resonance imaging (MRI) findings of neurosarcoidosis, particularly those involving nerve roots, are scarce in the literature. Methods We presented the case of neurosarcoidosis involving cervical nerve roots and cranial nerves, alongside a systematic literature review. Results A 28-year-old female suddenly developed right facial numbness as well as left upper extremity and left hand pain. Initial brain and spine MRI showed a bulging mass of T2 iso-to-high signal intensity in the left Meckel’s cave/trigeminal nerve, as well as diffuse enlargement of the right C6 and C7 nerve roots. Follow-up MRI at 2 months revealed a reduction in the size of the initial lesion and the appearance of new similar lesions on the contralateral side (right Meckel’s cave, left C3–C8 nerve roots). In particular, the lesions involving the nerve roots demonstrated central enlargement along the nerve roots, without involvement of the adjacent spinal cord. All these lesions exhibited enhancement, leading to the differentiation between sarcoidosis and lymphoma. Sarcoidosis was subsequently confirmed through biopsy of a hilar lymph node. Conclusions This report presents a distinctive MRI feature of neurosarcoidosis involving spinal nerve roots, representing the first of its kind, and describes the evolution of MRI findings throughout the clinical course.