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  1. Keserci B, Duc NM
    Int J Hyperthermia, 2018;35(1):626-636.
    PMID: 30307340 DOI: 10.1080/02656736.2018.1516301
    OBJECTIVE: This retrospective study aimed (1) to investigate the magnetic resonance imaging (MRI) features influencing a nonperfused volume ratio (NPVr) ≥ 90% after high-intensity focussed ultrasound (HIFU) ablation of adenomyosis, and (2) to assess the safety, which was defined in terms of adverse events (AEs) and changes in anti-Mullerian hormone (AMH) concentrations, and clinical efficacy, which was defined in terms of adenomyosis volume reduction and symptom improvement at 6 months' follow-up.

    METHODS: Sixty-six women who underwent HIFU treatment were divided into groups A (NPVr ≥90%; n = 26) and B (NPVr <90%, n = 40). Multivariate logistic regression analyses of MRI features were conducted to identify the potential predictors of an NPVr ≥90%.

    RESULTS: Generalized estimating equation (GEE) analysis was used to model the prediction of an NPVr ≥90% with four significant predictors from multivariate analyses: the thickness of the subcutaneous fat layer, adenomyosis volume, T2 signal intensity (SI) ratio of adenomyosis to myometrium, and the Ktrans ratio of adenomyosis to myometrium. Clinical efficacy was significantly greater in group A than in group B. The findings showed no serious AEs and no significant differences between AMH concentrations before and 6 months after treatment.

    CONCLUSIONS: The present retrospective study demonstrated that achievement of NPVr ≥90% as a measure of clinical treatment success in MRI-guided HIFU treatment of adenomyosis using multivariate analyses and a prediction model is clinically possible without compromising the safety of patients.

  2. Duc NM, Keserci B
    Diagn Interv Radiol, 2019 Sep;25(5):398-409.
    PMID: 31287428 DOI: 10.5152/dir.2019.18556
    High-intensity focused ultrasound (HIFU) is a minimally-invasive and non-ionizing promising technology and has been assessed for its role in the treatment of not only primary tumors but also metastatic lesions under the guidance of ultrasound or magnetic resonance imaging. Its performance is notably effective in neurologic, genitourinary, hepato-pancreato-biliary, musculoskeletal, oncologic, and other miscellaneous applications. In this article, we reviewed the emerging technology of HIFU and its clinical applications.
  3. Duc NM, Huy HQ, Keserci B, Thong PM
    Med Arch, 2020 Feb;74(1):42-46.
    PMID: 32317834 DOI: 10.5455/medarh.2020.74.42-46
    Introduction: Each country has its system of the training program, but to be concordant with the world in the radiology field, the process needs to have common points or common criteria. On maintaining the integrity of intersociety collaboration in the field of radiology, it is necessary to understand each country's training program for each specialty.

    Aim: This retrospective study aims to compare the postgraduate thesis characteristics from various sources in the field of radiology.

    Methods: This was a retrospective study evaluating data that is publicly available online and at libraries and institutional review board approval, as such, was not demanded. We selected 40 published theses from the library of Pham Ngoc Thach University of Medicine and University of Medicine and Pharmacy at Ho Chi Minh City and Hanoi Medical University in Vietnam which graduated from 2008 to 2018. Of these, there were 10 PhD, 10 specialists II, 10 master's, and 10 residency theses selected.

    Results: A total of 40 theses were analyzed from participants with a median age of 36.5. The male/female ratio was 23/17. Most of the theses were subspecialty in diagnostic radiology (87.5%) and focused on pathological radiology (95%). Adult patients were the major objectives of the theses accounted for 87.5% with predominant materials of magnetic resonance imaging counted for 47.5%. Theses in PhD group were the largest items regarding the total number of pages as well as the number of figures, and the number of references. Nonetheless, both domestic and international publications related to all theses were truly low.

    Conclusion: The postgraduate thesis of radiology in Vietnam has many different forms but mainly focuses on diagnostic and pathological radiology with materials of magnetic resonance imaging in adults. The number of international publications regarding the thesis was very small.

  4. Duc NM, Huy HQ, Nadarajan C, Keserci B
    Anticancer Res, 2020 May;40(5):2975-2980.
    PMID: 32366451 DOI: 10.21873/anticanres.14277
    BACKGROUND/AIM: Even though advanced magnetic resonance imaging (MRI) can effectively differentiate between medulloblastoma and ependymoma, it is not readily available throughout the world. This study aimed to investigate the role of simple quantified basic MRI sequences in the differentiation between medulloblastoma and ependymoma in children.

    PATIENTS AND METHODS: The institutional review board approved this prospective study. The brain MRI protocol, including sagittal T1-weighted, axial T2-weighted, coronal fluid-attenuated inversion recovery, and axial T1-weighted with contrast enhancement (T1WCE) sequences, was assessed in 26 patients divided into two groups: Medulloblastoma (n=22) and ependymoma (n=4). The quantified region of interest (ROI) values of tumors and their ratios to parenchyma were compared between the two groups. Multivariate logistic regression analysis was utilized to find significant factors influencing the differential diagnosis between the two groups. A generalized estimating equation (GEE) was used to create the predictive model for the discrimination of medulloblastoma from ependymoma.

    RESULTS: Multivariate logistic regression analysis showed that the T2- and T1WCE-ROI values of tumors and the ratios of T1WCE-ROI values to parenchyma were the most significant factors influencing the diagnosis between these two groups. GEE produced the model: y=exn/(1+exn) with predictor xn=-8.773+0.012x1 - 0.032x2 - 13.228x3, where x1 was the T2-weighted signal intensity (SI) of tumor, x2 the T1WCE SI of tumor, and x3 the T1WCE SI ratio of tumor to parenchyma. The sensitivity, specificity, and area under the curve of the GEE model were 77.3%, 100%, and 92%, respectively.

    CONCLUSION: The GEE predictive model can discriminate between medulloblastoma and ependymoma clinically. Further research should be performed to validate these findings.

  5. Tanyel T, Nadarajan C, Duc NM, Keserci B
    Cancers (Basel), 2023 Aug 08;15(16).
    PMID: 37627043 DOI: 10.3390/cancers15164015
    Machine learning (ML) models have become capable of making critical decisions on our behalf. Nevertheless, due to complexity of these models, interpreting their decisions can be challenging, and humans cannot always control them. This paper provides explanations of decisions made by ML models in diagnosing four types of posterior fossa tumors: medulloblastoma, ependymoma, pilocytic astrocytoma, and brainstem glioma. The proposed methodology involves data analysis using kernel density estimations with Gaussian distributions to examine individual MRI features, conducting an analysis on the relationships between these features, and performing a comprehensive analysis of ML model behavior. This approach offers a simple yet informative and reliable means of identifying and validating distinguishable MRI features for the diagnosis of pediatric brain tumors. By presenting a comprehensive analysis of the responses of the four pediatric tumor types to each other and to ML models in a single source, this study aims to bridge the knowledge gap in the existing literature concerning the relationship between ML and medical outcomes. The results highlight that employing a simplistic approach in the absence of very large datasets leads to significantly more pronounced and explainable outcomes, as expected. Additionally, the study also demonstrates that the pre-analysis results consistently align with the outputs of the ML models and the clinical findings reported in the existing literature.
  6. Duc NM, Huy HQ, Keserci B, Thong PM
    Acta Inform Med, 2020 Mar;28(1):71-74.
    PMID: 32210519 DOI: 10.5455/aim.2019.28.71-74
    INTRODUCTION: The advancement of gender equality within radiology, a predominantly male profession, has currently been a significant concern.

    AIM: Therefore, in this original study, we aimed to investigate the gender disparity in Vietnamese radiological societies.

    METHODS: No ethical committee or institutional review board approval was needed since the data were publicly available. In this retrospective study, we evaluated the faculties of four main radiological societies in Vietnam: Vietnamese society of radiology and nuclear medicine (VSRNM, n = 67); Radiological society of Ho Chi Minh City (RSHCM, n = 25); Vietnamese society of ultrasound in medicine (VSUM, n = 29); and Vietnamese society of interventional radiology (VSIR, n = 18).

    RESULTS: There are significantly fewer women than men in faculties of four main radiological societies (15.1% vs. 84.9%). None of the women served as a professor and leader of any radiological societies. The women with a doctor of philosophy level are relatively low among the four main radiological societies. Also, female interventional and pediatric radiologists are seriously low among four main radiological societies.

    CONCLUSIONS: In Vietnamese radiological societies, gender disparities exist, especially about educational degrees and professorship positions. Future studies are essential to address the underlying roots of the gender gap and aid in the implementation of gender diversity programs and policies.

  7. Jung SH, Kim J, Chung Y, Keserci B, Pyo H, Park HC, et al.
    Radiat Oncol J, 2020 Mar;38(1):52-59.
    PMID: 32229809 DOI: 10.3857/roj.2020.00101
    PURPOSE: To evaluate and compare the feasibilities of magnetic resonance (MR) image-based planning using synthetic computed tomography (sCT) versus CT (pCT)-based planning in helical tomotherapy for prostate cancer.

    MATERIALS AND METHODS: A retrospective evaluation was performed in 16 patients with prostate cancer who had been treated with helical tomotherapy. MR images were acquired using a dedicated therapy sequence; sCT images were generated using magnetic resonance for calculating attenuation (MRCAT). The three-dimensional dose distribution according to sCT was recalculated using a previously optimized plan and was compared with the doses calculated using pCT.

    RESULTS: The mean planning target volume doses calculated by sCT and pCT differed by 0.65% ± 1.11% (p = 0.03). Three-dimensional gamma analysis at a 2%/2 mm dose difference/distance to agreement yielded a pass rate of 0.976 (range, 0.658 to 0.986).

    CONCLUSION: The dose distribution results obtained using tomotherapy from MR-only simulations were in good agreement with the dose distribution results from simulation CT, with mean dose differences of less than 1% for target volume and normal organs in patients with prostate cancer.

  8. Keserci B, Duc NM, Nadarajan C, Huy HQ, Saizan A, Wan Ahmed WA, et al.
    Diagn Interv Radiol, 2020 May;26(3):207-215.
    PMID: 32209511 DOI: 10.5152/dir.2019.19157
    PURPOSE: We sought to present our preliminary experience on the effectiveness and safety of magnetic resonance imaging (MRI)-guided, high-intensity focused ultrasound (HIFU) therapy using a volumetric ablation technique in the treatment of Association of Asian Nations (ASEAN) patients with symptomatic uterine leiomyomas.

    METHODS: This study included 33 women who underwent HIFU treatment. Tissue characteristics of leiomyomas were assessed based on T2- and T1-weighted MRI. The immediate nonperfused volume (NPV) ratio and the treatment effectiveness of MRI-guided HIFU on the basis of the degrees of volume reduction and improvement in transformed symptom severity score (SSS) were assessed.

    RESULTS: The median immediate NPV ratio was 89.8%. Additionally, the median acoustic sonication power and HIFU treatment durations were 150 W and 125 min, respectively. At six-month follow-up, the median leiomyoma volume had decreased from 139 mL at baseline to 84 mL and the median transformed SSS had decreased from 56.2 at baseline to 18.8. No major adverse events were observed.

    CONCLUSION: The preliminary results demonstrated that volumetric MRI-guided HIFU therapy for the treatment of symptomatic leiomyomas in ASEAN patients appears to be clinically acceptable with regard to treatment effectiveness and safety.

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