• Investigative Magnetic Resonance Imaging
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• v.19 no.3
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• pp.162-167
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• 2015

Purpose: To evaluate the usefulness of quantitative analysis of the facial nerve using contrast-enhanced three-dimensional (CE 3D) fluid-attenuated inversion recovery-volume isotopic turbo spin echo acquisition (FLAIR-VISTA) for the diagnosis of Bell's palsy in pediatric patients. Materials and Methods: Twelve patients (24 nerves) with unilateral acute facial nerve palsy underwent MRI from March 2014 through March 2015. The unaffected sides were included as a control group. First, for quantitative analysis, the signal intensity (SI) and relative SI (RSI) for canalicular, labyrinthine, geniculate ganglion, tympanic, and mastoid segments of the facial nerve on CE 3D FLAIR images were measured using regions of interest (ROI). Second, CE 3D FLAIR and CE T1-SE images were analyzed to compare their diagnostic performance by visual assessment (VA). The sensitivity, specificity, and accuracy of RSI measurement and VA were compared. Results: The absolute SI of canalicular and mastoid segments and the sum of the five mean SI (total SI) were higher in the palsy group than in the control group, but with no significant differences. The RSI of the canalicular segment and the total SI were significantly correlated with the symptomatic side (P = 0.028 and 0.015). In 11/12 (91.6%) patients, the RSI of total SI resulted in accurate detection of the affected side. The sensitivity, specificity, and accuracy for detecting Bell's palsy were higher with RSI measurement than with VA of CE 3D FLAIR images, while those with VA of CE T1-SE images were higher than those with VA of CE 3D FLAIR images. Conclusion: Quantitative analysis of the facial nerve using CE 3D FLAIR imaging can be useful for increasing the diagnostic performance in children with Bell's palsy when difficult to diagnose using VA alone. With regard to VA, the diagnostic performance of CE T1-SE imaging is superior to that of CE 3D FLAIR imaging in children. Further studies including larger populations are necessary.

• Journal of the Korean Society of Radiology
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• v.7 no.4
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• pp.265-269
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• 2013

This report aims at picturing out the clinical usefulness by analyzing the signal intensity in choroid plexuses which produce cerebrospinal fluids by diffusion weighted imaging. At first, subjects were chosen among the patients who showed high in signal intensity by diffusion weighted imaging. The subjects were taken another test by fluid attenuated inversion recovery diffusion weighted echo planer image(FLAIR-DW-EPI) the signals of fluid attenuation. And it was found that there are differences between the signal intensities of the two methods, which showed that the signal intensity in FLAIR-DW-EPI is equal to or low than, that in the Brain. By this, it is felt that it is helpful to diagnose the disease in choroid plexus by testing another more with FLAIR-DW-EPI methods the patients who showed high in signal intensity in choroid plexus by $T2^*$ diffusion weighted echo planer image($T2^*$-DW-EPI).

• Journal of Medicine and Life Science
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• v.16 no.1
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• pp.1-5
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• 2019

Our purpose was to evaluate usefulness of the contrast-enhanced 3 dimensional fluid attenuated inversion recovery (3D-FLAIR) technique of half brain volume to diagnose the patients with facial neuritis based on segment-based analysis. We assessed retrospectively 17 consecutive patients who underwent brain MR imaging at 3 tesla for facial neuritis: 11 patients with idiopathic facial neuritis and 6 with herpes zoster oticus. Contrast enhanced 3D-FLAIR sequences of the half brain volume were analyzed and 3D T1-weighted sequence of the full brain volume were used as the base-line exam. Enhancement of the facial nerve was determined in each segment of 5 facial nerve segments by two radiologists. Sensitivity, specificity and accuracy of enhancement of each segment were assessed. The authors experienced a prompt fuzzy CSF enhancement in the fundus of the internal auditory canal in patients with enhancement of the canalicular segment. Interobserver agreement of CE 3D-FLAIR was excellent(${\kappa}$-value 0.885). Sensitivity, specificity, and accuracy of each segment are 1.0, 0.823, 0.912 in the canalicular segment; 0.118, 1.0, 0.559 in the labyrinthine segment; 0.823, 0.294, 0.559 in the anterior genu; 0.823, 0.529, 0.676 in the tympanic segment; 0.823, 0.235, 0.529 in the mastoid segment, respectively. In addition, those of prompt fuzzy enhancement were 0.647, 1.0, and 0.824, respectively. Incidence of prompt fuzzy enhancement with enhancement of the canalicular segment was 11 sites(55%): 6 (54.5%) in idiopathic facial neuritis and 5 (83.3%) in herpes zoster. Enhancement of the canalicular segment and prompt fuzzy enhancement on CE 3D-FLAIR was significantly correlated with occurrence of facial neuritis (p<0.001). CE 3D-FLAIR technique of the half brain volume is useful to evaluate the patients with facial neuritis as an adjunct sequence in addition to contrast-enhanced 3D T1-weighted sequence. On segment-based analysis, contrast enhancement of the canalicular segment is the most reliable. Prompt fuzzy enhancement is seen in not only herpes zoster, but in idiopathic facial neuritis.

• Investigative Magnetic Resonance Imaging
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• v.26 no.1
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• pp.32-42
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• 2022

Purpose: To evaluate the clinical benefit of 2D contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) image for detecting leptomeningeal metastasis (LM) in the brain metastasis work-up for lung cancer. Materials and Methods: From June 2017 to July 2019, we collected all consecutive patients with lung cancer who underwent brain magnetic resonance image (MRI), including contrast-enhanced 3D fast spin echo T1 black-blood image (CE-T1WI) and CE-T2 FLAIR; we recruited clinico-radiologically suspected LM cases. Two independent readers analyzed the images for LM in three sessions: CE-T1WI, CE-T2 FLAIR, and their combination. Results: We recruited 526 patients with suspected lung cancer who underwent brain MRI; of these, we excluded 77 (insufficient image protocol, unclear pathology, different contrast media, poor image quality). Of the 449 patients, 34 were clinico-radiologically suspected to have LM; among them, 23 were diagnosed with true LM. The calculated detection performance of CE-T1WI, CE-T2 FLAIR, and combined analysis obtained from the 34 suspected LM were highest in the combined analysis (AUC: 0.80, 0.82, and 0.89, respectively). The inter-observer agreement was also the highest in the combined analysis (0.68, 0.72, and 0.86, respectively). In quantitative analyses, CNR of CE-T2 FLAIR was significantly higher than that of CE-T1WI (Wilcoxon signed rank test, P < 0.05). Conclusion: Adding CE-T2 FLAIR might provide better detection for LM in the brain-metastasis screening for lung cancer.

• Investigative Magnetic Resonance Imaging
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• v.16 no.1
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• pp.25-30
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• 2012

Purpose : To compare the enhancement pattern of normal facial nerves on 3D-FLAIR and 3D-T1-FFE-F) sequences at 3.0 T MR units. Materials and Methods: We assessed 20 consecutive subjects without a history of facial nerve abnormalities who underwent temporal bone MRI with contrast enhancement between January 2008 and March 2009. Two neuroradiologists independently reviewed pre-/post-enhanced 3D-T1-FFE-FS and 3D-FLAIR images respectively with 2-week interval to assess the enhancement of normal facial nerves divided into five anatomical segments. The degree of enhancement in each segment was graded as none, mild or strong, and the results of 3D-FLAIR and 3D-T1-FFE-FS image sets were compared. Results: On 3D-FLAIR images, one of the two reviewers observed mild enhancement of the genu segment in two (10%) subjects. On 3D-T1-FFE-FS images, at least one segment of the facial nerve was enhanced in 13 (65%) subjects. At least one reviewer found that 17 of the 100 segments showed enhancement on 3D-T1-FFE-FS images, with the mastoid segment being the most commonly enhanced. Interobserver agreement on 3D-T1-FFE-FS images was good for enhancement of the normal facial nerve (${\kappa}$= 0.589). Conclusion: In contrast to 3D-T1-FFE-FS, normal facial nerve segments rarely showed enhancement on 3D-FLAIR images.

• Investigative Magnetic Resonance Imaging
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• v.3 no.2
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• pp.167-172
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• 1999

Purpose : To evaluate the detection rate of hyperacute intracerebral hemorrhage in echo planar imaging (EPI) and other MR sequences. materials and Methods : Intracerebral hemorrhage was experimentally induced in ten rats. EPI, fast spin-echo (FSE) T2 weighted images, fluid attenuated inversion recovery (FLAIR), spin-echo (SE) T1 weighted images and gradient echo (GE) T1 weight ed images of rat's brains were obtained 2 hours after onset of intracerebral hemorrhage. EPI and FSE T2 images were additionally obtained 30 min and 1 hour after onset of hemorrhage in 3 and 6 rat, repeatedly, For objective visual assessment, discrimination between the lesion and normal brain parenchyma was evaluated on various MR sequences by three radiologists. For quantitative assessment, contrast-to-noise ratio (CNR) was calculated fro hemorrhage-normal brain parenchyma. Statistical analysis was performed usning the Wilcoxon-Ranks test. Results : EPI, FLAIR, and FSE T2 images showed high signal intensity lesions. The lesion discrimination was easier on EPI than on other sequences, and also EPI showed higher signal intensity for the subjective visual assessment. In quantitative evaluation, CNR of the hemorrhagic lesion versus normal brain parenchyma were higher on EPI and FLAIR images (p<0.01). There was no difference in CNR between EPI and FLAIR (p>0.10). On MR images obtained 30 minutes and 1 hour after the onset of intracerebral hemorrhage, the lesion detection was feasible on both EPI and FSE T2 images showing high signal intensity. Conclusion : EPI showed higher detection rate as compared with other MR sequences and could be useful in early detection and evaluation of intracerebral hemorrhage.

• Investigative Magnetic Resonance Imaging
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• v.23 no.3
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• pp.210-219
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• 2019

Purpose: The purpose of this study was to investigate if double inversion recovery (DIR) imaging can have a role in the evaluation of brain ischemia, compared with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) imaging. Materials and Methods: Sixty-seven patients within 48 hours of onset, underwent MRI scans with FLAIR, DWI with b-value of 0 (B0) and $1000s/mm^2$, and DIR sequences. Patients were categorized into four groups: within three hours, three to six hours, six to 24 hours, and 24 to 48 hours after onset. Lesion-to-normal ratio (LNR) value was calculated and compared among all sequences within each group, by the Friedman test and conducted among all groups, for each sequence by the Kruskal-Wallis test. In qualitative assessment, signal intensity changes of DIR, B0, and FLAIR based on similarity with DWI and image quality of each sequence, were graded on a 3-point scale, respectively. Scores for detectability of lesions were compared by the McNemar's test. Results: LNR values from DWI were higher than DIR, but not statistically significant in all groups (P > 0.05). LNR values of DIR were significantly higher than FLAIR within 24 hours of onset (P < 0.05). LNR values were significantly different between, before, and after six hours onset time for DIR (P = 0.016), B0 (P = 0.008), and FLAIR (P = 0.018) but not for DWI (P = 0.051). Qualitative analysis demonstrated that detectability of DIR was higher, compared to that of FLAIR within 4.5 hours and six hours of onset (P < 0.05). Also, the DWI quality score was lower than that of DIR, particularly relative to infratentorial lesions. Conclusion: DIR provides higher detectability of hyperacute brain ischemia than B0 and FLAIR, and does not suffer from susceptibility artifact, unlike DWI. So, DIR can be used to replace evaluation of the FLAIR-DWI mismatch.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.442-450
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• 2024

Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

• Investigative Magnetic Resonance Imaging
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• v.15 no.1
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• pp.32-40
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• 2011

Purpose : The purpose of this study was to investigate the microstructural changes according to aging on the thickness and signal intensity (SI) of the cortical gray matter (GM) and white matter (WM) on the T2-, fluid-attenuated inversion recovery (FLAIR) and T1-weighted MR images in normal subjects. Materials and Methods : The 10, 20, 30, 40, 50, 60, 70, 80 and 90 year age groups of men and women (each 10 individuals) who underwent routine brain MRI, including the T2-, FLAIR and T1-weighted images, were selected for this study. We measured the thickness and the SI of the cortical GM and WM at the postcentral gyrus, which has an even thickness at the level of centrum semiovale, on the axial scans and we calculated the mean values of the thickness ratio of the gray/white matter (TRGW) and the signal intensity ratio of the gray/white matter (SRGW), and we compared the ratios of each age group. Results : On the T2-weighted images, the TRGWs were 0.81 and 0.79 at the age of 10 and they were 0.73 and 0.71 at the age of 90 in the men and women, respectively. So, the GM thickness was decreased more than the WM thickness was with aging. On the FLAIR images, the TRGWs were 1.09 and 1.00 at the age of 10 and they were 1.11 and 0.95 at the age of 70 in the men and women, respectively. On the T1-weighted images, the TRGWs were 0.66 and 0.80 at the age of 10, and the ratio was changed to 0.90 and 0.78 at the age of 90 in the men and women, respectively. On the T2-weighted image, the SRGWs were 1.53 and 1.43 at the age of 10, and they were 1.23 and 1.27 at the age of 90 in the men and women, respectively. On the FLAIR images, the SRGWs were 1.23 and 1.25 at the age of 10 and they were 1.06 and 1.05 at the age of 90 in the men and women, respectively. On the T1-weighted images, the SRGWs were 0.86 and 0.85 at the age of 10, and they were 0.90 and 0.87 at the age of 90 in the men and women, respectively. Conclusion : We suggest that the age-related microstructural changes of the thickness and the SI of the cortical GM and WM on the T2-, FLAIR and T1-weighted images are unique, and so this knowledge will be helpful to differentiate neurodegenerative disease from normal aging of the brain.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.302-308
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• 2013

Objective : MR perfusion and single photon emission computerized tomography (SPECT) are well known imaging studies to evaluate hemodynamic change between prior to and following superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis in moyamoya disease. But their side effects and invasiveness make discomfort to patients. We evaluated the ivy sign on MR fluid attenuated inversion recovery (FLAIR) images in adult patients with moyamoya disease and compared it with result of SPECT and MR perfusion images. Methods : We enrolled twelve patients (thirteen cases) who were diagnosed with moyamoya disease and underwent STA-MCA anastomosis at our medical institution during a period ranging from September of 2010 to December of 2012. The presence of the ivy sign on MR FLAIR images was classified as Negative (0), Minimal (1), and Positive (2). Regions were classified into four territories: the anterior cerebral artery (ACA), the anterior MCA, the posterior MCA and the posterior cerebral artery. Results : Ivy signs on preoperative and postoperative MR FLAIR were improved (8 and 4 in the ACA regions, 13 and 4 in the anterior MCA regions and 19 and 9 in the posterior MCA regions). Like this result, the cerebrovascular reserve (CVR) on SPECT was significantly increased in the sum of CVR in same regions after STA-MCA anastomosis. Conclusion : After STA-MCA anastomosis, ivy signs were decreased in the cerebral hemisphere. As compared with conventional diagnostic modalities such as SPECT and MR perfusion images, the ivy sign on MR FLAIR is considered as a useful indicator in detecting brain hemodynamic changes between preoperatively and postoperatively in adult moyamoya patients.