• Radiation Oncology Journal
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• v.15 no.3
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• pp.207-213
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• 1997

Purpose : Intracranial germinoma is the most radiocurable tumor of theprimary intracranial neoplasm. But, the optimum radiation dose and target volume remain controversial In this retrospective study, we analysed the spreading pattern at presentation and the pattern of the failure and survival of intracranial germinoma, Materials and Methods : From 1989 to 1996, 23 Patients were treated for intracranial germinoma at Department of Radiation Oncology, Twenty-one Patients were treated at their initial Presentation and 2 Patients were treated for recurrent disease. Six patients had multiple tumor masses on MRI and 7patients had ventricular seeding on MRI. The examination of cerebrospinal fluid cytology was done in 15 patients and 3 out of 15 patients had positive cerebrospinal cytology. In tumor marker study of $\alpha-FP\;and\;\beta-hCG$, 6 patients had mildly elevated $\beta-hCG$ in serum or cerebrospinal fluid. Twentyone Patients were treated with whole craniospinal axis irradiation and 2 Patients were given whole ventricular radiation therapy. The total dose was ranged between 4500cGy and 5600cGy to primary tumor site (median 5580cGy) Dose to the entire ventricular system ranged from 1980cGy to 3960 cGy (median 2700cGy) and dose to the spinal axis ranged from 2160cGy to 3900cGy (median 2700cGy) Results : Of 23 patients, 21 Patients are alive without evidence of diseasefor median 4 years follow-up. One Patient who had markedly elevated $\alpha-FP\;and\;\beta-hCG$, suffered from Persistent disease after radiation therapy and received 2 cycles of chemotherapy. She died 9 months after chemotherapy One patient who developed ventricular seeding after gamma-knife was treated with whole craniospinal irradiation, he died after 1 year due to probably brain necrosis. The hematologic toxicity of 3 or 4 grade were seen in 7 patients and patient's endocrinologic dysfunction was not deteriorated after radiation therapy. One patient had been treated with growth hormone replacement due to short stature. Conclusions : This retrospective study has confirmed the excellent result of radiation therapy in intracranial germinoma. The complication rate during or after radiation therapy is considered within acceptable range. ft is necessary to further investigate the optimal dose and treatment volume of radiation therapy. The role of chemotherapy in the treatment of intracranial germinoma should be further investigated.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1066-1079
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• 2023

Purpose Distinguishing intradural extramedullary (IDEM) spinal ependymoma from myxopapillary ependymoma is challenging due to the location of IDEM spinal ependymoma. This study aimed to investigate the utility of clinical and MR imaging features for differentiating between IDEM spinal and myxopapillary ependymomas. Materials and Methods We compared tumor size, longitudinal/axial location, enhancement degree/pattern, tumor margin, signal intensity (SI) of the tumor on T2-weighted images and T1-weighted image (T1WI), increased cerebrospinal fluid (CSF) SI caudal to the tumor on T1WI, and CSF dissemination of pathologically confirmed 12 IDEM spinal and 10 myxopapillary ependymomas. Furthermore, classification and regression tree (CART) was performed to identify the clinical and MR features for differentiating between IDEM spinal and myxopapillary ependymomas. Results Patients with IDEM spinal ependymomas were older than those with myxopapillary ependymomas (48 years vs. 29.5 years, p < 0.05). A high SI of the tumor on T1W1 was more frequently observed in IDEM spinal ependymomas than in myxopapillary ependymomas (p = 0.02). Conversely, myxopapillary ependymomas show CSF dissemination. Increased CSF SI caudal to the tumor on T1WI was observed more frequently in myxopapillary ependymomas than in IDEM spinal ependymomas (p < 0.05). Dissemination to the CSF space and increased CSF SI caudal to the tumor on T1WI were the most important variables in CART analysis. Conclusion Clinical and radiological variables may help differentiate between IDEM spinal and myxopapillary ependymomas.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.121-126
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• 2011

The author reports a bile duct cancer patient whose stent shifted significantly from right to left over the course of radiotherapy. The 80-year-old female patient had a short stature with thoracic kyphosis and mutiple spinal compression fractures. She was also emaciated and very lean. By comparing the weekly scanned computed tomography images, the author found her stent to have shifted by more than 4 cm from right to left over the course of external beam radiotherapy. The results of this case study suggest that for a very lean and emaciated kyphotic bile duct cancer patient, the possibility of large interfractional movement of the bile duct or stent during radiotherapy should be considered.

• Progress in Medical Physics
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• v.15 no.2
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• pp.70-76
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• 2004

The most important work for early detection of liver cancer and decision of its characteristic and location is good segmentation of a liver region from other abdominal organs. This paper proposes a fully automatic liver segmentation algorithm based on the abdominal morphology characteristic as an easy and efficient method. Multi-modal threshold as pre-processing is peformed and a spine is segmented for finding morphological coordinates of an abdomen. Then the liver region is extracted using C-class maximum a posteriori (MAP) decision and morphological filtering. In order to estimate results of the automatic segmented liver region, area error rate (AER) and correlation coefficients of rotational binary region projection matching (RBRPM) are utilized. Experimental results showed automatic liver segmentation obtained by the proposed algorithm provided strong similarity to manual liver segmentation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.706-711
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• 1996

다발성 골수증은 다양한 증세를 보이는 형질세포로부터 기원하는 악성종양으로 40세이상의 남성에서 호발되며 alkylating agent 단독, 혹은 corticosteroid와 병용하는 항암제 치료로 생존율이 크게 증가되기는 하였지만 치료후 평균생존기간의 20개월 내외로 완치율이 그다지 높지않은 형편이다. 악골에서의 발생은 극히 드물고 대개 늑골, 편평골, 척추, 골반, 두개골등에 광범위한 patchy destruction의 형태로 나타나는데 악골에 발생할 경우 임상증상은 장기적인 무통성 종창이 가장 흔하며 때로는 동통, 악골의 팽창, 감각이상, 치아의 동요, 악골골절등을 보이기도 한다. 전신적증상으로 무력감, 체중감소, 빈혈, 신부전, hypercalcemia, hyperiviscosity syndrome을 나타내기도 하는데 약 10%의 환자에서 전신적인 amyloidosis를 보인다. 진단은 골수생검상 골수의 plasmacytosis가 10% 이상이면서 혈장이나 뇨전기영동법에서 monoclonal globulin peak이 있을 때 가능하다. 여러 학자들은 처음에는 독립적인 고립성병소로 나타났다가 장기적으로 다발성골수종으로 이행됨을 주장하면서 장기적인 추적을 권하고 있지만 골내 고립성 형질세포종(solitary plasmacytoma in bone), 수질외 형질세포종(extramedullary plasmacytoma) 등은 다발성골수종과는 다른 질환이라 주장하는 등 아직 많은 논란이 있는 형편이다. 치료는 $4000{\sim}6000$ rad의 방사선치료와 여러 가지 약제의 복합적인 항암요법이 사용되고 있으며 국소적인 병소의 경우 외과적 절제술이 추천되기도 한다. 저자들은 59세 여자환자에서 하악골에 발생된 다발성골수종을 치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Progress in Medical Physics
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• v.27 no.2
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• pp.86-92
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• 2016

An absorbed dose calculation method using a digital phantom is implemented in normal organs. This method cannot be employed for calculating the absorbed dose of tumor. In this study, we measure the S-value for calculating the absorbed dose of each organ and tumor. We inject a radioisotope into a torso phantom and perform Monte Carlo simulation based on the CT data. The torso phantom has lung, liver, spinal, cylinder, and tumor simulated using a spherical phantom. The radioactivity of the actual absorbed dose is measured using the injected dose of the radioisotope, which is Cu-64 73.85 MBq, and detected using a glass dosimeter in the torso phantom. To perform the Monte Carlo simulation, the information on each organ and tumor acquired using the PET/CT and CT data provides anatomical information. The anatomical information is offered above mean value and manually segmented for each organ and tumor. The residence time of the radioisotope in each organ and tumor is calculated using the time activity curve of Cu-64 radioactivity. The S-values of each organ and tumor are calculated based on the Monte Carlo simulation data using the spatial coordinate, voxel size, and density information. The absorbed dose is evaluated using that obtained through the Monte Carlo simulation and the S-value and the residence time in each organ and tumor. The absorbed dose in liver, tumor1, and tumor2 is 4.52E-02, 4.61E-02, and 5.98E-02 mGy/MBq, respectively. The difference in the absorbed dose measured using the glass dosimeter and that obtained through the Monte Carlo simulation data is within 12.3%. The result of this study is that the absorbed dose obtained using an image can evaluate each difference region and size of a region of interest.

• Radiation Oncology Journal
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• v.15 no.1
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• pp.11-18
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• 1997

Purpose : To evaluate the efficacy of combined treatment of surgery and chemoradiotherapy for supratentorial primitive neuroectodermal tumors (SPNET) and obtain the Prognostic factors and complications Materials and Methods .The a9e of 18 patients ranged from 1 to 27 years (median=5 years). There were 12 males and 6 females The extents of surgery were gross total (n:9), subtotal (n:8), biopsy only (n: 1). Craniospinal radiotherapy was delivered to all the patients except 2 patients who were treated only with the whole brain and primary lesion. Radiation dose were 3120-5800cGy (median=5460) to primary mass, 1500-4200cGy (median=3600cGy) to the whole brain and 1320-3600cGy (median= 2400 cGy) to the spinal axis. Chemotherapy was done in 13 patients. Median follow-up period was 45 months ranged from 1 to 89 months. Results : Patterns of failure were as follows; local recurrence (1), multiple intracranial recurrence (2), spinal seeding (3), craniospinal seeding (2) and multiple bone metastasis (1). Two of two patients who did not received craniospinal radiotherapy failed at spinal area. All the relapsed cases died at 1 to 13 months after diagnosis of progression. The 2- and 5-rear overall survival rates were $61\%\;and\;49\%$, respectively The a9e, sex, tumor location did not influence the survival but aggressive resection with combined chemotherapy showed better outcome. Among 9 survivors, complications were detected as radiation necrosis (n=1), hypopituitarism (n=2), cognitive defect(n=1), memory deficit (n=1), growth retardation (n=1). Conclusion : To improve the results of treatment of SPNET, maximal surgical resection followed by radiation therapy and chemotherapy is necessary. The extended radiation field including craniospinal axis may reduce the recurrence in spinal axis.

• Development and Reproduction
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• v.2 no.2
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• pp.189-196
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• 1998

Several lines of evidence indicate that some neuropeptides classically associated hypothalamus have been found in pituitary gland, suggesting the existence of local regulation of pituitary function. Among the hypothalamic releasing hormones, genes for TRH and GnRH are expressed in the rat anterior pituitary gland. The present study was carried out to investigate the expression of the GHRH gene in rat anterior pituitary and the pituitary-derived cell lines. The presence of GHRH transcripts in pituitary tissue was shown by 3'rapid amplification of cDNA end (3'-RACE) analysis. In reverse transcription-polymerase chain reaction (RT-PCR) study, GHRH cDNA fragments were amplified from two pituitary-derived cell lines, $\alpha$T3 cells originated from mouse gonadotrope and GH3 cells from rat somatolactotrope. Immunoreactive GHRH was detected in large and medium-sized pituitary cells by immunocytochemistry. Significant amounts of GHRH-like molecules were found in the GH3 cell extracts. In RNase protection assay, the level of pituitary GHRH mRNA was augmented by ovariectomy. These results demonstrate that GHRH gene is expressed in the rat gonadotropes and somatotropes, and suggest that the pituitary GHRH could be participated in the paracrine and/or autocrine regulation of cell proliferation, as well as promoting growth hormone secretion.

• Investigative Magnetic Resonance Imaging
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• v.13 no.1
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• pp.54-62
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• 2009

Purpose : Craniospinal neurenteric (NE) cysts are rare developmental non-neoplastic cysts of the central nervous system with diverse MR imaging findings. The purpose of this study was to evaluate various MR imaging findings of intracranial and intraspinal NE cysts. Materials and Methods : We retrospectively reviewed the MR imaging findings of six NE cysts that were confirmed by pathology. We evaluated anatomic location, signal intensity, size and enhancement pattern of NE cysts. Results : Two intracranial lesions were located extra-axially in the cerebellopontine angle and quadrigeminal cisterns. Three spinal lesions were intraduralextramedullary cysts, located ventral to the spinal cord, but one thoracic lesion was an intramedullary cyst. The signal intensity of the cysts was hyperintense on T1-weighted images as compared with the cerebrospinal fluid (CSF) for two intracranial lesions and one cervical lesion. In addition, all intracranial lesions showed diffusion restriction. For the remaining three spinal lesions, the signal intensity was nearly the same as the signal intensity of the CSF as seen on both T1- and T2-weighted images. On contrast-enhanced studies, two intracranial cysts showed a small nodular enhancement and one thoracic spinal lesion showed rim enhancement. Conclusion : NE cysts have various locations, signal intensities, and possible focal nodular or rim enhancement. Therefore, NE cysts can be included in the differential diagnosis of various craniospinal cystic or tumorous cystic lesions.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.970-976
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• 2023

This study reports on diffuse leptomeningeal glioneuronal tumor (DL-GNT) in a 29- year-old male. DL-GNT is a rare central nervous system (CNS) tumor mostly seen in children and only few cases have been reported in adult patients. Our patient presented with a chronic headache that lasted for five months. MR imaging showed mild hydrocephalus, multiple rim-enhancing nodular lesions in the suprasellar cistern, diffuse leptomeningeal enhancement in the lumbosacral area, and multiple small non-enhancing cyst-appearing lesions not suppressed on fluid attenuated inversion recovery (FLAIR) images in the bilateral basal ganglia, thalami, and cerebral hemispheres. Under the impression of germ cell tumor with leptomeningeal seeding, the patient underwent trans-sphenoidal tumor removal. DL-GNT was pathologically confirmed and FGFR1 mutation was detected through a next-generation sequencing test. In conclusion, a combination of leptomeningeal enhancement and multiple parenchymal non-enhancing cyst-appearing lesions not suppressed on FLAIR images may be helpful for differential diagnosis despite overlapping imaging features with many other CNS diseases that have leptomeningeal enhancement.