• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.130-134
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• 1997

Purpose: To analyze contrast-enhancement pattern of stomach cancer on dynamic MRI and to verify the efficacy of intravenous contrast agent in the evaluation of stomach cancer. Materials and Methods: Twelve patients with proven stomach cancer underwent dynamic MRI. By using l.OT scanner, we obtained precontrast FLASH images, and 30, 60, 90 second delay FLASH images after intravenous contrast injection. All patients ingested one liter of water and had intramuscular injection of Buscopan just before MR study. For quantitative analysis we measured signal to noise ratio (SiN) of stomach cancer on each image, and signal difference to noise ratio (SD/N) between cancer and intraluminal fluid, cancer and the pancreas. For qualitative analysis two radiologists evaluated lesion conspicuity on each image by grading system(grade 0, 1, 2, 3: poor, fair, good, excellent). Results: SiN of stomach cancer increased gradually by time(precontrast, 30, 60, 90 second delay: 38.7, 42.5, 57.4, 65.7). SD/N between cancer and intraluminal fluid significantly increased after contrast enhancement(l.24, 25.01, 39.30, 45.89). SD/Ns between cancer and the pancreas were 10.5, 9.33, 9.99, 10.66, respectively. In qualitative analysis, precontrast images were better than postcontrast images for delineation of stomach cancer. Postcontrast images showed clear endo-Iuminal side of stomach cancer, but outer margin of stomach cancer was more distinct on precontrast images. Conclusion: Precontrast MR images are better than postcontrast MR images in the depiction of stomach cancer. Intravenous contrast agent is not imperative in the evaluation of stomach cancer.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.89-95
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• 1998

Purpose : To investigate the phosphorus metabolic abnormalities in skeletal muscle of patients with mitochondrial myopathy using in vivo $^{31}P$ magnetic resonance spectroscopy(MRS). Materials and Methods : Patients with mitochondrial myopathy(N=10) and normal control subjects (N=10) participated. All in vivo $^{31}P$ MRS examinations were performed on 1.5T whole-body MRI/MRS system by using an image selected in vivo spectroscopy (ISIS) pulse sequence that provided a $4{\times}4{\times}4{\;}cm^{3}$ volume of interest (VOI) in the right thigh muscle tissue. Peak areas for each phophorus methabolite were measured using a Marquart algorithm. Results : The specific features in patients with mitochondrial myopathy were a significant increase of Pi/PCr ratio (p=0.003) and a significant decrease of ATP/PCr ratio (p=0.004) as compared with normal controls. In particular, the ${\beta}-ATP/PCr$ ratio between controls and patients with mitochondrial myopathy was predominantly altered. Conclusions : In vivo $^{31}P$ MRS may be a useful modality in the clinical evaluation of patients with mitochondrial myopathy based on ATP/PCr and Pi/PCr ratios in skeletal muscle tissue and provides a valuable information in further understanding disorders of muscle metabolism.

• Korean Journal of Radiology
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• v.25 no.1
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• pp.11-23
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• 2024

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm² was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). Conclusion: Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

• Progress in Medical Physics
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• v.13 no.3
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• pp.120-128
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• 2002

To investigate differences between the metabolic ratios of normal controls and brain tumors such as astrocytomas and glioblastoma multiforme (GM) by proton MR spectroscopy (MRS) at 37 high field system. Using 3T MRI/MRS system, localized water-suppressed single-voxel technique in patients with brain tumors was employed to evaluate spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cr) and lactate. On the basis of Cr, these peak areas were quantificated as a relative ratio. The variation of metabolites measurements of the designated region in 10 normal volunteers was less than 10%. Normal ranges of NAA/Cr and Cho/Cr ratios were 1.67$\pm$018 and 1.16$\pm$0.15, respectively. NAA/Cr ratio of all tumor tissues was significantly lower than that of the normal tissues (P=0.005). Cho/Cr ratio of glioblastoma multiforme was significantly higher than that of astrocytomas (P=0.001). Lactate was observed in all tumor cases. The present study demonstrated that the neuronal degradation or loss was observed in all tumor tissues. Higher grade of brain tumors was correlated with higher Cho/Cr ratio, indicating a significant dependence of Cho levels on malignancy of gliomas. This results suggest that clinical proton MR spectroscopy could be useful to predict tumor malignancy.

• Investigative Magnetic Resonance Imaging
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• v.9 no.1
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• pp.2-8
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• 2005

Purpose : The purpose of this study was to implement a software to visualize tumor and its surrounding fiber tracts simultaneously using diffusion tensor imaging and examine the feasibility of our software for investigating the influence of tumor on its surrounding fiber connectivity. Material and Methods : MR examination including T1-weigted and diffusion tensor images of a patient with brain tumor was performed on a 3.0 T MRI unit. We used the skull-striped brain and segmented tumor images for volume/surface rendering and anatomical information from contrast-enhanced T1-weighted images. Diffusion tensor images for the white matter fiber-tractography were acquired using a SE-EPI with a diffusion scheme of 25 directions. Fiber-tractography was performed using the streamline and tensorline methods. To correct a spatial mismatch between T1-weighted and diffusion tensor images, they were coregistered using a SPM. Our software was implemented under window-based PC system. Results : We successfully implemented the integrated visualization of the fiber tracts with tube-like surfaces, cortical surface and the tumor with volume/surface renderings in a patient with brain tumor. Conclusion : Our result showed the feasibility of the integrated visualization of brain tumor and its surrounding fiber tracts. In addition, our implementation for integrated visualization can be utilized to navigate the brain for the quantitative analysis of fractional anisotropy to assess changes in the white matter tract integrity of edematic and peri-edematic regions in a number of tumor patients.

• Investigative Magnetic Resonance Imaging
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• v.12 no.1
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• pp.33-39
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• 2008

Purpose : There is debate concerning the observation of metabolite changes on MRS at the designated cortex during some tasks. The purpose of this study is to assess the change of the lactate content at the motor cortex during hand-grasping tasks with performing real-time fMRI-guided fMRS. Materials and Methods : Seven healthy volunteers (23-28 years old) underwent realtime fMRI during right hand grasping tasks with using a 1.5 T system. After confirming the activating area, single voxel MRS was preformed at 1) the baseline, 2) during the task and 3) after the task on the activating cortex. The three consecutive spectra were compared for observing the changes of the lactate content by the tasks. The Cho/Cr, NAA/Cr and Lac/Cr ratios were calculated manually from those spectra. Results : MRS during the tasks revealed the lactate peaks at the 1.33 ppm resonance frequency with great conspicuity at the activated area, which was identified on the real-time fMRI. After the task scan, the lactate peaks completely disappeared and the spectra recovered to the values of the baseline scan in all volunteers. At baseline, during the task and after the task, the Cho/Cr ratios were 0.81, 0.76 and 0.77, respectively, and the NAA/Cr ratios were 1.68, 1.65 and 1.72, respectively, and the Lac/Cr ratios were 0.28, 0.41 and 0.30, respectively. During the task, Lac was significantly increased by 46%. Conclusion : We observed prominent lactate peaks on MRS during hand-grasping tasks at the activated area, as was shown on the real-time fMRI. We suggest that fMRS can be used as a sensitive tool for observing the metabolite changes of the functioning brain.

• Progress in Medical Physics
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• v.10 no.3
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• pp.159-168
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• 1999

Cardiac disease is one of the leading causes of death in Korea. In quantitative analysis of cardiac function and morphological information by three-dimensional reconstruction of magnetic resonance images, left ventricle provides an important role functionally and physiologically. However, existing procedures mostly rely on the extensive human interaction and are seldom evaluated on clinical applications. In this study, we developed a system which could perform automatic extraction of enpicardial and endocardial contour and analysis of cardiac function to evaluate reliability and stability of each system comparing with the result of ARGUS system offered 1.5T Siemens MRI system and manual method performed by clinicians. For various aspects, we investigated reliability of each system by compared with left ventricular contour, end-diastolic volume (EDV), end-systolic volume (ESV), stock volume (SV), ejection fraction (EF), cardiac output (CO) and wall thickness (WT). When comparing with manual method, extracted results of developed process using minimum error threshold (MET) method that automatically extracts contour from cardiac MR images and ARGUS system were demonstrated as successful rate 90% of the contour extraction. When calculating cardiac function parameters using MET and comparing with using correlation coefficients analysis method, the process extracts endocardial and epicardial contour using MET, values from automatic and ARGUS method agreed with manual values within :t 3% average error. It was successfully demonstrated that automatic method using threshold technique could provide high potential for assessing of each parameters with relatively high reliability compared with manual method. In this study, the method developed in this study could reduce processing time compared with ARGUS and manual method due to a simple threshold technique. This method is useful for diagnosis of cardiac disease, simulating physiological function and amount of blood flow of left ventricle. In addition, this method could be valuable in developing automatic systems in order to apply to other deformable image models.

• Journal of Life Science
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• v.20 no.4
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• pp.549-554
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• 2010

Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulders of baseball pitchers. The purpose of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist shoulder muscle strength in collegiate baseball pitchers with humeral head retroversion diagnosed through MRI. The dominant and non-dominant shoulders of 9 asymptomatic baseball pitchers were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Biodex system 3 isokinetic dynamometer at speeds of $90^{\circ}/s$ and $180^{\circ}/s$. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. Total range of motion, measured at $90^{\circ}$ of glenohumeral abduction, was $180.1^{\circ}$ for dominant shoulders and $183.7^{\circ}$ for non-dominant shoulders. Humeral head retroversion measured $47.6{\pm}6.1^{\circ}$ in dominant and $37.8{\pm}5.3^{\circ}$ in non-dominant extremities. The mean internal rotator concentric contraction (IR-Con) showed a significant difference compared to $31.5{\pm}5.1$ (Nm) in dominant and $38.7{\pm}5.2$ (Nm) in non-dominant shoulders at $180^{\circ}/s$ (p<0.05). The mean external rotator eccentric contraction (ER-Ecc) showed a significant difference compared to $20.3{\pm}4.7$ (Nm) in dominant and $25.1{\pm}3.7$ (Nm) in non-dominant shoulders at $90^{\circ}/s$ (p<0.05). There is a pattern of increased external rotation and decreased internal rotation in the dominant extremity that significantly correlates with an increase in humeral retroversion.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.264-273
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• 2002

Purpose : Three-dimensional radiation dosimetry using magnetic resonance imaging of polymer gel was recently introduced. This dosimetry system is based on radiation induced chain polymerization of acrylic monomers in a muscle equivalent gel and provide accurate 3 dimensional dose distribution. We planned this study to evaluate the clinical value of this 3-dimensional dosimetry. Materials and Methods: The polymer gel poured into a cylindrical glass flask and a spherical glass flask. The cylindrical test tubes were for dose response evaluation and the spherical flasks, which is comparable to the human head, were for isodose curves. T2 maps from MR images were calculated using software, IDL. Dose distributions have been displayed for dosimetry. The same spherical flask of gel and the same irradiation technique was used for film and TLD dosimetry and compared with each other. Results : The R2 of the gel respond linearly with radiation doses in the range of 2 to 15 Gy. The repeated dosimetry of spherical gel showed the same isodose curves. These isodose curves were identical to dose distributions from treatment planning system especially high dose range. In addition, the gel dosimetry system showed comparable or superior results with the film and TLD dosimetry. Conclusion : The 3-dimensional dosimetry for conformal radiation therapy using MRI of polymer gal showed stable and accurate results. Although more studies are needed for convenient clinical application, it appears to be a useful tool for conformal radiation therapy.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.97-102
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• 1994

Objectives : Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively. The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. Methods : By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, were found to be unresectable at operating room, were selected for this study. Out of 64 patients, 42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. Results : Among 42 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55%(23 patients) and suspicious for unresectable tumors in 45%(19 patients). The causes of unresectability were technically unresectable T3 lesions in 7%(3 patients), T4 lesions in 62%(26 patients), N2 lesions in 17%(7 patients) and N3 lesions in 14%(6 patients). Conclusion : The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT(like MRI) is indicated in selected NSCLC cases.