Surachate Siripongsakun - Academia.edu (original) (raw)

Papers by Surachate Siripongsakun

Obstetrics and Gynecology International

Objectives. To evaluate the competency of medical sonographer students who have completed trainin... more Objectives. To evaluate the competency of medical sonographer students who have completed training to estimate the gestational age (GA) and perform fetal biometric measurements compared to obstetricians. Methods. We conducted a cross-sectional observational study at the end of the medical sonographer students’ practice sessions. In total, 80 midtrimester (18–28 weeks) pregnant women were recruited, and an ultrasound was performed according to the International Society of Sonography in Obstetrics and Gynecology (ISUOG) guideline. Estimated GA calculated from fetal biometric measurements was compared between medical sonographer students and qualified obstetricians. Subsequently, images were randomly evaluated by maternal-fetal medicine specialists to assess the measurement performance. Results. There was no significant difference in the estimated GA between the medical sonographer students and obstetricians (mean difference, 0.01 ± 2.92 day, p = 0.89). However, there was a significan...

PLOS ONE

Significant liver fibrosis regression occurs after hepatitis C virus (HCV) therapy. However, the ... more Significant liver fibrosis regression occurs after hepatitis C virus (HCV) therapy. However, the impact of direct-acting antivirals (DAAs) on steatosis is less clear. This study was aimed at evaluating serial fibrosis and steatosis alterations in patients with HCV genotype 1, who achieved sustained virological response (SVR). We enrolled 55 HCV mono-infected and 28 HCV/HIV co-infected patients receiving elbasvir/grazoprevir from a clinical trial. Fibrosis and steatosis were assessed at baseline, follow-up week-24 (FUw24) and week-72 (FUw72) by magnetic resonance elastography (MRE) and proton density fat fraction (PDFF), respectively. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409, transmembrane six superfamily member 2 (TM6SF2) rs58542926 and membrane bound O-acyltransferase domain-containing 7 (MBOAT7) rs641738 polymorphisms were determined by allelic discrimination. Overall, mean MRE decreased significantly from baseline to FUw24 and FUw72. At FUw72, pati...

Hepatology Research

Aim: Fibrosis regression has been observed in patients with chronic hepatitis C virus (HCV) infec... more Aim: Fibrosis regression has been observed in patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antivirals. This study was aimed at evaluating dynamic changes of serum Mac-2-binding protein glycosylation isomer (M2BPGi) in patients with HCV genotype 1 receiving elbasvir/grazoprevir. Methods: M2BPGi were serially measured at baseline, during and after therapy. Its diagnostic performance at baseline and sustained virological response at 24 weeks after treatment (SVR24) were compared with transient elastography (TE) and the aspartate aminotransferase/platelet ratio index (APRI) using magnetic resonance elastography (MRE) as a reference. Results: Overall, 60 HCV mono-infected and 36 HCV/HIV co-infected patients were included with SVR24 rates of 93.3% and 97.2%, respectively. At baseline, TE, M2BPGi and APRI were correlated with MRE (r = 0.788, r = 0.703 and r = 0.564, respectively, p < 0.001). The area under the receiver operator characteristics curves for TE, M2BPGi and APRI in differentiating significant fibrosis were 0.88 (95% confidence interval; 0.81-0.95, p < 0.001), 0.86 (0.79-0.94, p < 0.001) and 0.74 (0.64-0.83, p < 0.001), respectively. The corresponding figures for cirrhosis were 0.95 (0.90-1.00, p < 0.001), 0.96 (0.92-1.00, p < 0.001) and 0.88 (0.79-0.97, p < 0.001), respectively. Compared with baseline, all fibrosis markers significantly declined after achieving SVR24. The correlations of TE, M2BPGi and APRI with MRE at time of SVR24 were r = 0.587 (p < 0.001), r = 0.457 (p < 0.001) and r = 0.293 (p = 0.004), respectively. In multivariate analysis, high baseline alanine aminotransferase level, HCV mono-infection and advanced fibrosis were factors associated with M2BPGi reduction.

Ultrasound in Medicine & Biology, 2017

Radiology requires practitioners to appreciate how normal anatomy appears on imaging and to under... more Radiology requires practitioners to appreciate how normal anatomy appears on imaging and to understand the basis of diseases that may be observed.

HPB, 2021

Background: Ultrasound (US) is increasingly used as a bedside diagnostic tool, with training cour... more Background: Ultrasound (US) is increasingly used as a bedside diagnostic tool, with training courses for non-radiologists being developed. However, the training time constraint is an important barrier for non-radiologists. We therefore created a short self-learning course for liver-US for non-radiologists. Aim: Assess the participants' ability in identifying the organ structures during a liver-US. Method: A short video-lecture on liver-US training and a portable guidebook for image acquisition were developed. Eighteen non-radiologist physicians studied the course and attended hands-on liver-US examinations to capture the assigned images and label the acquired organ/structures, which were evaluated by an expert radiologist. Result: 130 liver-US examinations were performed, 44 (33.8%) was cirrhosis. The overall of mean image acquisition score was 84.5 ± 9.7%. The mean score of the 1st examination was 75.2 ± 16.4. The mean score was >80% since the 2nd examination. The score was significant lower in cirrhotic cases as compared to non-cirrhotic cases (78.8 ± 17.3 vs. 88.3 ± 14.4, p = 0.001). The participants' year of study and experience in previous US training did not affect the image acquisition score. Conclusion: The liver-US training course in a short video format with a portable guidebook is effective and relatively low time-consuming for teaching non-radiologists to perform bedside liver-US.

The ASEAN Journal of Radiology, 2020

Sonographer school, HRH Princess Chulabhorn College of Medical Science: The first step of the son... more Sonographer school, HRH Princess Chulabhorn College of Medical Science: The first step of the sonographer system in Thailand Ultrasound is a diagnostic imaging tool, which is convenient, inexpensive and it provides non-radiation exposure. Thus, it is commonly used in a real-time diagnostic method in almost all medical fields. Nowadays, medical technology is widely used along with much more advanced development and ultrasound is considered a medical disruptive technology that is expected to expand in a wider scale in the near future.

Physica Medica, 2020

This study aimed to determine a low-dose protocol for digital chest tomosynthesis (DTS). Methods:... more This study aimed to determine a low-dose protocol for digital chest tomosynthesis (DTS). Methods: Five simulated nodules with a CT number of approximately 100 HU with size diameter of 3, 5, 8, 10, and 12 mm were inserted into an anthropomorphic chest phantom (N1 Lungman model), and then scanned by DTS system (Definium 8000) with varying tube voltage, copper filter thickness, and dose ratio. Three radiophotoluminescent (RPL) glass dosimeters, type GD-352 M with a dimension of 1.5 × 12 mm, were used to measure the entrance surface air kerma (ESAK) in each protocol. The effective dose (ED) was calculated using the recorded total dose-area-product (DAP). The signal-to-noise ratio (SNR) was determined for qualitative image quality evaluation. The image criteria and nodule detection capability were scored by two experienced radiologists. The selected low-dose protocol was further applied in a clinical study with 30 pulmonary nodule follow-up patients. Results: The average ESAK obtained from the standard default protocol was 1.68 ± 0.15 mGy, while an ESAK of 0.47 ± 0.02 mGy was found for a low-dose protocol. The EDs for the default and low-dose protocols were 313.98 ± 0.72 µSv and 100.55 ± 0.28 µSv, respectively. There were small non-significant differences in the image criteria and nodule detection scoring between the low-dose and default protocols interpreted by two radiologists. The effective dose of 98.87 ± 0.08 µSv was obtained in clinical study after applying the low-dose protocol. Conclusions: The low-dose protocol obtained in this study can substantially reduce radiation dose while preserving an acceptable image quality compared to the standard protocol.

Abdominal Radiology, 2019

Background and objective Cholangiocarcinoma (CCA) is an aggressive malignancy with high prevalenc... more Background and objective Cholangiocarcinoma (CCA) is an aggressive malignancy with high prevalence rate in Asia. The CCA premalignant lesions, including Biliary intraepithelial neoplasia (Bil-IN) and Intraductal papillary neoplasm of biliary tract (IPNB), share a common carcinogenesis; however, on imaging, patterns of presentation are different. Patterns and imaging characteristics on ultrasonography (US) and Magnetic resonance imaging (MRI) of both Bil-IN and IPNB are reported herein. Methods In this retrospective study of imaging findings in premalignant CCA, pathology-proven cases of Bil-IN and IPNB at Chulabhorn Hospital were analyzed. Demographics, locations of lesions, imaging characteristics of both Bil-IN and IPNB were assessed, compared, and described. Results Twenty-one premalignant lesions, 13 Bil-INs and 8 IPNBs, from 18 patients were included. Both Bil-IN and IPNB lesions were found more commonly at the right than left intrahepatic ducts (66.7% vs. 33.3%), and had more peripheral than central locations (85.7% vs. 14.3%). On US, Bil-IN commonly presented as focal bile duct dilatation (76.9%), whereas IPNB was more variable with hyperechoic nodules (37.5%), focal bile duct dilatation (37.5%), and diffuse bile duct dilatation with intraductal nodules (25%). On MRI, focal bile duct dilatation and nonfunctioning bile excretion are the most sensitive findings with sensitivities in the range of 84.6% to 100%. The presence of intraductal nodules and connection to the biliary system are findings that were significantly different between IPNB and Bil-IN, 62.5% versus 7.7% (p = 0.014) and 75% versus 15.4% (p = 0.018), respectively. Conclusions Premalignant lesions of CCA, including Bil-IN and IPNB, have different imaging presentations. Knowledge of imaging presentations may improve early detection and increase confidence in diagnosis. Keywords Premalignant lesion • Cholangiocarcinoma • Liver imaging • Malignant (non-HCC) • Biliary intraepithelial neoplasia • Bil-IN • Intraductal papillary neoplasm of biliary tract, IPNB • Opisthorchis viverrini Abbreviations Bil-IN Biliary intraepithelial neoplasm CCA Cholangiocarcinoma CS Clonorchis sinensis CT Computed tomography GRE Gradient recoiled echo IPNB Intraductal papillary neoplasm of biliary tract MRCP Magnetic resonance cholangiopancreatography MRI Magnetic resonance imaging OV Opisthorchis viverini US Ultrasonography

Journal of gastroenterology and hepatology, Jan 16, 2017

Cholangiocarcinoma (CCA) is an aggressive malignancy with rapid progression and poor prognosis. A... more Cholangiocarcinoma (CCA) is an aggressive malignancy with rapid progression and poor prognosis. Abdominal ultrasound surveillance may detect early-stage malignancy and improve surgical outcome. However, little data exists on the benefits of abdominal ultrasound surveillance in populations at high risk for CCA development in an endemic area. This study compared survival outcomes of CCA patients recruited through abdominal ultrasound surveillance program and those presented to the hospital independent of surveillance. The surveillance population-based cohort was 4,225 villagers in Northern Thailand, aged 30-60 years, who consented to a 5-year abdominal ultrasound surveillance program which included interval ultrasound examinations every 6 months. The non-surveillance cohort was hospital-based CCA patients diagnosed during April 2007-November 2015. Numbers of operable tumors, percentages of R0 resection, and survival analyses were compared between the two cohorts. There were48 and 192 ...

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, Jan 22, 2016

Incidental small pancreatic cystic lesions (PCLs) are often found on pre-operative imaging in pat... more Incidental small pancreatic cystic lesions (PCLs) are often found on pre-operative imaging in patients undergoing orthotropic liver transplantation (OLT).While these are considered benign or of low malignant potential, the influence of immunosuppression after OLT may be of concern. The aim of this study was to observe the long term outcome of these small pancreatic cystic lesions (PCLs) in post OLT patients. An institutional OLT database of 1,778 consecutive OLT patients from January 2000 to December 2010 was analyzed. Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) or Endoscopic ultrasonography (EUS) at the time of OLT and all subsequent imaging, cytology, fluid analysis of PCLs, and patient status were evaluated. A total of 70 patients with 182 PCLs, of benign or low malignant potential, were identified with a mean follow up time of 64 months. At initial diagnosis of PCLs in 48 patients, seven branch duct intraductal papillary mucinous neoplasm (B-IPMN), one serous ...

World Journal of Gastroenterology, 2016

Author contributions: Ungtrakul T carried out the literature review, study design, statistical an... more Author contributions: Ungtrakul T carried out the literature review, study design, statistical analysis, manuscript drafting and revision; Chun-on P, Siripongsakun S, Worakitsitisatorn A and Vidhayakorn S carried out data collection and imaging analyses; Boonchuay W and Dechma J contributed to data collection and patient coordination; Sornsamdang G was responsible for the analysis of serum alphafetoprotein and liver function tests; Soonklang K carried out the statistical analysis; Laohapand C and Sriprayoon T contributed to the literature review and study design; Mahidol C, Tanwandee T and Auewarakul CU contributed to proposal development, data analysis and monitoring, and manuscript revision; all authors read and approved the final manuscript.

Abdominal radiology (New York), Jan 6, 2016

To retrospectively determine whether hepatobiliary phase (HBP) sequence outperforms unenhanced T1... more To retrospectively determine whether hepatobiliary phase (HBP) sequence outperforms unenhanced T1-weighted imaging (uT1wI) in distinguishing the ablation margin (AM) from hepatocellular carcinoma (HCC) 24 h after thermoablation. Ninety-one patients [mean age, 65.7 years; 68 M/23F] with 138 HCCs (>6 months follow-up) underwent pre- and postablation gadoxetate disodium-enhanced MRI. AM showed a hyperintense middle zone (MZ) surrounding central hypo- or hyperintense HCCs on uT1wI, and an intermediate-intense MZ encompassing central hypo- or hyperintense HCCs during HBP. The visible AM was defined as persistent MZ around HCCs, which were demarcated from MZ, or peripherally band encompassing MZ, which were not demarcated from HCC. The indefinite AM was defined as no demarcating HCCs from MZ. The ability to distinguish AM from HCC was classified as visible or indefinite on axial (ax)-uT1wI, ax-HBP, coronal (cor)-HBP, and combined all images. To investigate the AM visibility during HBP,...

BMC Cancer, 2016

Background: Thailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north ... more Background: Thailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits. Methods: A 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30-60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months. Results: During the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41-62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one-and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One-and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opisthorchis viverrini, based on polymerase chain reaction. Conclusion: Detection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.

Journal of vascular and interventional radiology : JVIR, Jan 21, 2016

To evaluate preliminary outcomes after microwave ablation (MWA) of hepatocellular carcinoma (HCC)... more To evaluate preliminary outcomes after microwave ablation (MWA) of hepatocellular carcinoma (HCC) up to 5 cm and to determine the influence of tumor size. Electronic records were searched for HCC and MWA. Between January 2011 and September 2014, 173 HCCs up to 5 cm were treated by MWA in 129 consecutive patients (89 men, 40 women; mean age, 66.9 y ± 9.5). Tumor characteristics related to local tumor progression and primary and secondary treatment efficacy were evaluated by univariate analysis. Outcomes were compared between tumors ≤ 3 cm and tumors > 3 cm. Technical success, primary efficacy, and secondary efficacy were 96.5%, 99.4%, and 94.2% at a mean follow-up period of 11.8 months ± 9.8 (range, 0.8-40.6 mo). Analysis of tumor characteristics showed no significant risk factor for local tumor progression, including subcapsular location (P = .176), tumor size (P = .402), and perivascular tumor location (P = .323). The 1-year and 2-year secondary or overall treatment efficacy rat...

Abdominal radiology (New York), Apr 2, 2016

To compare the amount of tissue contraction after microwave (MW) versus radiofrequency (RF) ablat... more To compare the amount of tissue contraction after microwave (MW) versus radiofrequency (RF) ablation of liver tumors. Seventy-five hepatic tumors in 65 patients who underwent percutaneous MW or RF ablations were included in this retrospective study. All patients underwent MRI within 6 months before the ablation and 24 h after the procedure. Two blinded radiologists, by consensus, performed measurements on the corresponding series of pre and post-ablation MRI. Absolute and relative contraction of liver, tumor, and control were calculated and compared. Thirty-one patients underwent MW ablations, and 44 patients underwent RF ablations. The absolute and relative contraction of the ablation zone were significantly greater with MW than RF ablation (p = 0.003 to <0.001). Thirty-two lesions were visible on both pre- and post-ablation MRI. MW ablation had significantly more tumor contraction as compared to RF ablation (p = 0.003 to 0.009). The control measurements demonstrated no signific...

American Journal of Roentgenology, 2015

The objective of our study was to determine quantitative differences to differentiate low-grade f... more The objective of our study was to determine quantitative differences to differentiate low-grade from high-grade dysplastic nodules (DNs) and low-grade from highgrade hepatocellular carcinomas (HCCs) using gadoxetate disodium-enhanced MRI. MATERIALS AND METHODS. A retrospective study of 149 hepatic nodules in 127 consecutive patients who underwent gadoxetic acid-enhanced MRI was performed. MRI signal intensities (SIs) of the representative lesion ROI and of ROIs in liver parenchyma adjacent to the lesion were measured on unenhanced T1-weighted imaging and on dynamic contrast-enhanced MRI in the arterial, portal venous, delayed, and hepatobiliary phases. The relative SI of the lesion was calculated for each phase as the relative intensity ratio as follows: [mass SI / liver SI]. RESULTS. Of the 149 liver lesions, nine (6.0%) were low-grade DNs, 21 (14.1%) were high-grade DNs, 83 (55.7%) were low-grade HCCs, and 36 (24.2%) were high-grade HCCs. The optimal cutoffs for differentiating low-grade DNs from high-grade DNs and HCCs were an unenhanced to arterial SI of ≥ 0 or a relative SI on T2-weighted imaging of ≤ 1.5, with a positive predictive value (PPV) of 99.2% and accuracy of 88.6%. The optimal cutoffs for differentiating low-grade HCCs from high-grade HCCs were a relative hepatobiliary SI of ≤ 0.5 or a relative T2 SI of ≥ 1.5, with a PPV of 81.0% and an accuracy of 60.5%. CONCLUSION. Gadoxetate disodium-enhanced MRI allows quantitative differentiation of low-grade DNs from high-grade DNs and HCCs, but significant overlap was seen between low-grade HCCs and high-grade HCCs.

Hepatology International, 2015

There has been a global trend in the reduction of cancer-related mortality, especially in high-in... more There has been a global trend in the reduction of cancer-related mortality, especially in high-income countries [1]. Primary prevention, screening programs, minimally invasive therapies, targeted chemotherapy, and better palliative treatments can explain, at least in part, this global trend. One of the possible consequences of the longer survival of patients with cancer is an increased frequency of adverse events related to treatment and the disease itself. Gastrointestinal (GI) bleeding is one of the most common causes of admission to the emergency room of oncology centers. In our experience, the bleeding source is the tumor itself in more than 80 % of patients with a primary malignancy located in the upper GI tract [2]. The performance of risk scoring systems in predicting the clinical outcomes of upper GI bleeding from malignancy is unclear. The ideal risk scoring system should accurately identify low risk patients who could be eligible for early discharge, differentiating them from high risk patients who should be managed in the intensive care unit.

Hepatology, 2015

Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is an independent predictor of poo... more Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is an independent predictor of poor outcomes subsequent to surgical resection or liver transplantation (LT); however, MVI currently cannot be adequately determined preoperatively. Radiogenomic venous invasion (RVI) is a contrast-enhanced computed tomography (CECT) biomarker of MVI derived from a 91-gene HCC "venous invasion" gene expression signature. Preoperative CECTs of 157 HCC patients who underwent surgical resection (N 5 72) or LT (N 5 85) between 2000 and 2009 at three institutions were evaluated for the presence or absence of RVI. RVI was assessed for its ability to predict MVI and outcomes. Interobserver agreement for scoring RVI was substantial among five radiologists (j 5 0.705; P < 0.001). The diagnostic accuracy, sensitivity, and specificity of RVI in predicting MVI was 89%, 76%, and 94%, respectively. Positive RVI score was associated with lower overall survival (OS) than negative RVI score in the overall cohort (P < 0.001; 48 vs. >147 months), American Joint Committee on Cancer tumor-nodemetastasis stage II (P < 0.001; 34 vs. >147 months), and in LT patients within Milan criteria (P < 0.001; 69 vs. >147 months). Positive RVI score also portended lower recurrence-free survival at 3 years versus negative RVI score (P 5 0.001; 27% vs. 62%). Conclusion: RVI is a noninvasive radiogenomic biomarker that accurately predicts histological MVI in HCC surgical candidates. Its presence on preoperative CECT is associated with early disease recurrence and poor OS and may be useful for identifying patients less likely to derive a durable benefit from surgical treatment.