• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.107-111
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• 2011

Objective : The aim of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography focusing tracheostomy tube and innominate artery for prevention of tracheoinnominate artery fistula. Methods : The authors retrospectively analyzed 22 patients with tracheostomy who had checked CT angiography. To evaluate the relationship between tracheostomy tube and innominate artery, we divided into three categories. First proximal tube position based on cervical vertebra, named "tracheostomy tube departure level (TTDL)". Second, distal tube position and course of innominate artery, named "tracheostomy tube-innominate artery configuration (TTIC)". Third, the gap between the tube and innominate artery, named "tracheostomy tube to innominate artery gap (TTIG)". The TTDL/TTIC and TTIG are based on 3-dimensional (3D) reconstruction around tracheostomy and enhanced axial slices of upper chest, respectively. Results : First, mean TTDL was $6.8{\pm}0.6$. Five cases (23%) were lower than C7 vertebra. Second, TTIC were remote to innominate artery (2 cases; 9.1 %), matched with it (14 cases; 63.6%) or crossed it (6 cases; 27.3%). Only 9% of cases were definitely free from innominate artery injury. Third, average TTIG was $4.3{\pm}4.6$ mm. Surprisingly, in 6 cases (27.3%), innominate artery, trachea wall and tracheostomy tube were tightly attached all together, thus have much higher probability of erosion. Conclusion : If low TTDL, match or crossing type TTIC with reverse-L shaped innominate artery, small trachea and thin TTIG are accompanied all together, we may seriously consider early plugging and tube removal.

• 대한영상의학회지
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• 제83권1호
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• pp.3-27
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• 2022

심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.

• Journal of Korean Neurosurgical Society
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• 제45권5호
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• pp.284-288
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• 2009

Objective : Our retrospective study aimed to determine whether 16-slice computerized tomography (CT) angiography optimized sharp kernel is suitable for the evaluation of visibility, luminal patency and re-stenosis of intracranial stents in comparison with conventional angiography. Methods : Fifteen patients with symptomatic intracranial stenotic lesions underwent balloon expandable stent deployment of these lesions (10 middle cerebral arteries, 2 intracranial vertebral arteries, and 3 intracranial internal carotid arteries). CT angiography follow-up ranged from 6 to 15 months (mean follow-up, 8 months) after implantation of intracranial stents and conventional angiography was confirmed within 2 days. Curved multiplanar reformations with maximal intensity projection (MIP) with optimal window settings for assessment of lumen of intracranial stents were evaluated for visible lumen diameter, stent patency (contrast distal to the stent as an indirect sign), and re-stenosis by two experienced radiologists who blinded to the reports from the conventional angiography. Results : All of stents deployed into symptomatic stenotic lesions. All stents were classified as patent and no re-stenosis, which was correlated with results of conventional angiography. Parts of the stent lumen could be visualized in all cases. On average, 57% of the stent lumen diameter was visible using optimized sharp kernel. Significant improvement of lumen visualization (22%, p<0.01) was observed using the optimized sharp kernel compared with the standard sharp kernel. Inter-observer agreements on the measurement of lumen diameter and density were judged as good, respectively (p<0.05). Conclusion : Sixteen-slice CT using the optimized sharp kernel may provide a useful information for evaluation of lumen diameter patency, and re-stenosis of intracranial stents.

• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.125-129
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• 2006

Objective : The purpose of this study is to identify any differential point in computerized tomographic[CT] findings between aneurysmal subarachnoid hemorrhage[ASAH] and traumatic subarachnoid hemorrhage[TSAH], which sometimes make us not confident in differentiation. Methods : CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. Results : Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. Conclusion : As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH > 1mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.

• 한국정보과학회논문지:소프트웨어및응용
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• 제30권12호
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• pp.1247-1254
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• 2003

현재 경동맥 내막절제술 시행을 위한 경동맥 협착증의 정도 측정에는 디지털감산조영술(DSA), 회전조영술(rotational angiography), 컴퓨터단층조영술(CTA) 및 자기공명조영술(MRA)로부터 얻어진 경동맥의 투영 영상을 이용하여 북미, 유럽 표준 및 총경동맥 방법이 사용되고 있다. 본 논문에서는 기존의 기계적인 측경기를 이용하는 전형적인 경동맥 협착 측정 방법의 단점을 극복하고, 측정자간의 변화율을 최소화하기 위해 자기공명조영술의 단면 영상을 사용하고 컴퓨터화한 새로운 협착증 정도 측정 방법을 개발하였다. 영상 분할에 사용되는 방법중 가장 널리 사용되고 효율적인 명암값 임계치 방법을 사용하여 경동맥 및 동맥의 내강을 분할하였다. 또한, 각 증례의 측정된 총경동맥의 혈관두께를 사용하여 분할된 경동맥으로부터 혈관을 제거 하였고, 혈관이 제거된 경동맥을 혈류 영역과 플라그 영역으로 분할하였다. 각 단면 영상에서의 경동맥 협착증 정도 측정은 (분할된 플라그 영역/혈류영역 및 플라그를 합한 면적) * 100% 식으로 계산된다.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.413-415
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• 2007

A 26-year-old man was admitted to our department due to intermittent left hemiparesis for 3 months. Magnetic resonance Image showed subacute infarction in the right precentral gyrus. Digital subtraction angiography and magnetic resonance angiography revealed an aneurysmal protrusion at the right middle cerebral artery (MCA) bifurcation. It was difficult to differentiate the aneurysm from the occlusion of the middle trunk of the MCA trifurcation. Brain single photon emission computerized tomography showed a decrease in perfusion in the right posterior frontal lobe without vascular reserve. Therefore, we planned a superficial temporal artery MCA anastomosis with an exploration of the right MCA bifurcation. Intraoperatively, the aneurysmal opacification on preoperative angiography proved to be the proximal stump of the occluded middle trunk of the MCA trifurcation. An aneurysmal protrusion at the MCA bifurcation does not always indicate an aneurysm. In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered according to their angioanatomical appearance and the history of the patient.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1157-1159
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• 1996

총 대퇴동맥 거대동맥류는 드문 질환이며, 수술 시기를 놓치면 하지 절단을 초래하거나 사망할수도 있기 때문에 적절한 시기에 반드시 수술적 치료를 하여야 한다. 환자는 72세 남자로 입원 20일 전부터 생긴, 좌측 서혜부 박동성 종괴를 주소로 입원하였다. 전산화 단층 촬영과 디지탈 감쇄조영술로 총 대퇴동맥 거대동맥류를 진단하고 응급수술을 시행하였다. 수술은 동맥류를 절제하고 표재성 및 심부 대퇴동맥을 PTFE (Gore-tex) 인조혈관을 이용하여 연결하였다. 동맥류 원인은 병리 조직검사상 동맥경화성으로 밝혀졌다.

• Tuberculosis and Respiratory Diseases
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• 제56권1호
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• pp.85-90
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• 2004

Rasmussen 동맥류는 공동성 폐결핵에 동반되어 종종 대량객혈을 일으킬 수 있어 임상적으로 중요하다. 그동안 이의 존재나 치료에 대한 보고는 간헐적으로 있어왔으나 본 증례와 같이 기관지내시경으로 직접 병변을 관찰하고 나선식 CT로 Rasmussen 동맥류의 존재를 확인한 경우는 없어 이에 보고하는 바이다. 또한 기관지 내시경 검사시 발견되는 종양 형태의 병변에는 이와 같은 혈관성병변도 있을 수 있으므로 생검 등의 침습적 검사시에 보다 신중해질 필요가 있으며, 기존 질환이 진행된 공동성 폐결핵일 경우에는 더욱 주의를 필요로 한다.

• Journal of Yeungnam Medical Science
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• 제12권2호
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• pp.400-404
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• 1995

국소 결절성 과형성은 섬유성 격막에 의해 나누어지는 간세포와 Kupffer 세포의 결절로 이루어진 양성 종괴이다. 방사선학적으로 다른 종괴와 유사한 소견을 보이나 그 예후와 치료는 달라 감별이 요구된다. 저자들이 경험한 증례는 조영 후 영상을 조영전기영상과 조영후기영상으로 분리함으로써 종괴의 혈류형태를 관찰할 수 있는 급속조영 CT를 설시하여 감별진단에 도움을 받을 수 있었고 병리조직학적으로 국소 결절성 과형성으로 확인된, 급속조영 CT 설시 후 국내에서 보고되는 최초의 증례이다.

• 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.