• Korean Journal of Radiology
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• 제25권6호
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• pp.575-588
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• 2024

Objective: Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to high-resolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA. Materials and Methods: In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.25³ mm³ or 0.2³ mm³, respectively. A neurointerventionist established the gold standard with digital subtraction angiography. We compared the performance of HR-MRA, PD-MRA (0.25³-mm³ voxel), and PD-MRA (0.2³-mm³ voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement. Results: The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.25³-mm³ voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%-91.0% versus 66.7%-70.5%; specificity from 93.7%-96.8% versus 58.7%-68.3%; and accuracy from 90.8%-92.9% versus 63.8%-69.5% (P ≤ 0.003). Furthermore, PD-MRA (0.25³-mm³ voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators (P ≤ 0.013). The diagnostic accuracy of PD-MRA (0.2³-mm³ voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.25³-mm³ voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820-0.938) than in HR-MRA (0.447-0.510). Conclusion: PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.

• 한국정보과학회논문지:소프트웨어및응용
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• 제31권7호
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• pp.939-948
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• 2004

본 논문에서는 동일 환자에 대해 시간차를 두고 촬영한 뇌 CT-CT 혈관조영영상간 움직임을 보정하기 위한 강인하고 고속의 정합방법을 제안한다. 먼저, 두 영상에서 3차원 경계검출 기법을 이용하여 특징점을 추출하고, 기준영상에서는 이를 지역적 가중치 3차원 거리맵으로 변환한다. 부유영상을 기준영상으로 강체변환하면서 두 경계간의 상관관계가 최대인 위치를 탐색한다. 이 때, 최대위치가 더 이상 변화하지 않고 일정 이상 반복되면 해당위치를 최적위치로 하여 부유영상을 최적위치로 변환시켜 두 영상을 정합한다. 실험을 위하여 인공영상을 사용하여 정화성과 강인성을 평가하였고, 육안평가를 위하여 뇌 CT-CT 혈관조영영상을 사용하였다. 본 제안방법은 지역적 가중치 3차원 거리맵을 이용함으로써 적은 샘플링 개수에도 국부최대인 위치에 수렴하지 않고 최적위치로 강인하면서 고속으로 영상이 정합되었다

• 대한한방내과학회지
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• 제21권5호
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• pp.729-738
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• 2000

Objective : We examined patients admitted to Dong Eui University Oriental Medical Hospital from 1st January to 31st December in 2000. We studied 110 cases of patients who were diagnosed as Brain stem(pons, mid brain, medullar) infarction with brain CT, MRI scan, MR Angiography. Methods : We analyzed patients into sex, age, onset time, invasion lesion, past and family history, risk factor, abnormal vital sign for early 2 weeks, prodromal symptoms, symptoms at entry, progress and incidental symptoms at acute stage, complications, the state of condition at discharge, demonstrations, herb medications, western and oriental medical cooperation and admission period. Results : Our study was similar to existing studies in the distribution of sex, age, past and family history and risk factors. But there was some differences in the prodromal symptoms, symptoms at entry progress and incidental symptoms at acute stage, and the state of condition at discharge. Conclusions : Our study shows the brain stem infarction patients differed from other cerebrovascular accident patients in the symptoms. We hoped that our study would be further studied in western and oriental medicine.

• Clinical and Experimental Pediatrics
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• 제58권9호
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• pp.354-357
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• 2015

Parry-Romberg syndrome (PRS) is a rare, acquired disorder characterized by progressive unilateral facial atrophy of the skin, soft tissue, muscles, and underlying bony structures that may be preceded by cutaneous induration. It is sometimes accompanied by ipsilateral brain lesions and neurological symptoms. Here we present the case of a 10-year-old girl with right-sided PRS and recurrent monoplegic ataxia of the left leg. At 4 years of age, she presented with localized scleroderma over the right parietal region of her scalp; her face gradually became asymmetric as her right cheek atrophied. Brain magnetic resonance imaging revealed hemiatrophy of the face and skull base, and T2-weighted images showed increased signal in the right hemipons and hemicerebellar peduncle. Magnetic resonance angiography findings were unremarkable. She was treated with oral prednisolone, and her recurrent gait ataxia diminished within 2 months of the follow-up period. To the best of our knowledge, this is only the second case of PRS presenting with an abnormal involvement of the ipsilateral hemipons.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.384-388
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• 2001

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.252-255
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• 2011

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.256-259
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• 2011

We report a rare case of Williams syndrome accompanying moyamoya disease in whom postoperative global cerebral infarction occurred unpredictably. Williams syndrome is an uncommon hereditary disorder associated with the connective tissue abnormalities and cardiovascular disease. To our knowledge, our case report is the second case of Williams syndrome accompanying moyamoya disease. A 9-year-old boy was presented with right hemiparesis after second operation for coarctation of aorta. He was diagnosed as having Williams syndrome at the age of 1 year. Brain MRI showed left cerebral cortical infarction, and angiography showed severe stenosis of bilateral internal carotid arteries and moyamoya vessels. To reduce the risk of furthermore cerebral infarction, we performed indirect anastomosis successfully. Postoperatively, the patient recovered well, but at postoperative third day, without any unusual predictive abnormal findings the patient's pupils were suddenly dilated. Brain CT showed the global cerebral infarction. Despite of vigorous treatment, the patient was not recovered and fell in brain death one week later. We suggest that in this kind of labile patient with Williams syndrome accompanying moyamoya disease, postoperative sedation should be done with more thorough strict patient monitoring than usual moyamoya patients. Also, we should decide the revascularization surgery more cautiously than usual moyamoya disease. The possibility of unpredictable postoperative ischemic complication should be kept in mind.

• 대한중풍순환신경학회지
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• 제10권1호
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• pp.54-61
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• 2009

Arteriosclerosis is a pathologic term that contains hardening of arterial wall, loss of arterial elasticity and stenosis of artery. To diagnose this disease, conventional angiography, MRA, transcranial doppler ultrasonography are commonly used. And it causes various clinical phases by a region of the disease. In oriental medicine, arteriosclerosis is classified into congested fluids(痰飮), blood stasis(瘀血), stagnation of Gi(氣滯) and treated by Herb-Med, acupuncture, cupping, moxibustion, and the like. The purpose of this study was to investigate the effect of oriental medical therapy on cerebral arteriosclerosis. A patient with cerebrovascular disease admitted due to dizziness, mild dysarthria, tinnitus, anxiety disorder and his Brain MRA showed severe arteriosclerosis in right anterior cerebral artery(ACA) and middle cerebral artery(MCA). Every day, we administered to patient Herb Med and Herb pills. Also, acupuncture, moxibustion were done, too. As a result of the treatment, the patient's follow up Brain MRA showed improved state of ACA stenosis.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.155-159
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• 2012

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

• Journal of Korean Neurosurgical Society
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• 제51권2호
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• pp.91-93
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• 2012

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered.