• 대한족부족관절학회지
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• 제7권2호
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• pp.208-217
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• 2003

Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.

• Investigative Magnetic Resonance Imaging
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• 제19권4호
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• pp.231-236
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• 2015

A 17-year-old girl presented with complaints of headache and decreasing vision of one month's duration, without any history of fever, weight loss, or any evidence of an immuno-compromised state. Her neurological examination was normal, except for papilledema. Laboratory investigations were within normal limits, except for a slightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerized tomography of her head revealed complex mass in left frontal lobe with a concentric, slightly hyperdense, thickened wall, and moderate perilesional edema with mass effect. Differential diagnoses considered in this case were pilocytic astrocytoma, metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla (3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe with two concentric layers of T2 hypointense wall, with T2 hyperintensity between the concentric ring. Moderate perilesional edema and mass effect were seen. Post gadolinium study showed a markedly enhancing irregular wall with some enhancing nodular solid component. No restricted diffusion was seen in this mass in diffusion weighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increased lactate and lipid peaks in the central part of this mass, although some areas at the wall and perilesional T2 hyperintensity showed an increased choline peak without significant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease in relative cerebral blood volume at this region. These features in MRI were suggestive of brain abscess. The patient underwent craniotomy with excision of a grayish nodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioid cell granulomas, caseation necrosis and Langhans giant cells in histopathology, were conclusive of tubercular abscess. Tubercular brain abscess is a rare manifestation that simulates malignancy and cause diagnostic dilemma. MRI along with MRS and magnetic resonance perfusion studies, are powerful tools to differentiate lesions in such equivocal cases.

• 대한비뇨기종양학회지
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• 제15권3호
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• pp.131-136
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• 2017

Purpose: The aim of this study is to investigate the criteria of biochemical recurrence (BCR) and follow-up periods and methods with and without blood and imaging test of urologic oncology before established guidelines of prostate cancer in Korea. Materials and Methods: In December 2015, we sent the questionnaire to urologic oncologist in academic hospital and received the answer from 108 urologic oncologist (50%). Also, we analyzed the data of 1,141 patients underwent radical prostatectomy in 2005 from Korean Medical Insurance. Results: In follow-up, 72 physicians (66.7%) performed blood test every 3 months, 51 physicians (47.2%) performed imaging study in case of BCR. Bone scan was the most common imaging study in the follow-up (74 physicians, 68.5%). But, bone scan was only performed in case of BCR (43 physicians, 39.8%). The criteria of BCR was PSA 0.2 ng/mL (75 physician, 69.4%), 76 physicians (70.4%) was performed different follow-up according to risk of patients. In Korean Medical Insurance data analysis, PSA were performed average 2 times every year and magnetic resonance imaging, computed tomography, Bone scan were performed average 0.1, 0.2, 0.1 times every year, respectively. Conclusions: The criteria of BCR and the follow-up of prostate cancer patients in Korea were similar Korean prostate cancer guidelines. Blood and imaging test might be increased compared to 10 years ago, it is necessary to compare the Korean Medical Insurance data between 10 years ago and present.

• 한국방사선학회논문지
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• 제15권4호
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• pp.555-564
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• 2021

시상은 신경 기능 조절에 중요한 역할을 하는 것으로 알려져 있다. 뇌의 중앙에 위치한 시상은 수면, 각성, 감정 조절에 관여하며, 다발성 경화증, 본태성 떨림, 파킨슨병과 같은 신경퇴행성 질환과 관련이 있는 것으로 보고되고 있다. 또한, 시상의 철 침전물이 나이가 들면서 우울 증상을 유발할 수 있다는 보고가 있다. 연구 간에 차이가 있지만, 시상과 감정 조절, 처리 등의 신경 기능이 밀접한 관계가 있어 시상 영역이 신경 장애에 분명한 영향을 미친다고 추론할 수 있다. Tractography 분석을 통해 각 피질하 영역의 세부 영역 간의 연결성을 매트릭스 형태로 조사하여 강한 연결성과 약한 반구간 연결성을 보였다. 60세 이상 그룹에서 시상의 WM 연결성이 두 그룹보다 약한 것으로 나타났다. 두 그룹을 비교한 결과 젊은 그룹(10-39세 및 40-59세)가 60세 이상 그룹보다 연결 강도가 높았고 각 반구에서 3개의 연결 경로에서 통계적으로 유의한 차이가 발견되었다. 노화로 인한 시상 관련 연결 강도의 감소는 불안 및 우울증과 같은 정서적 및 신경학적 장애에 영향을 미칠 수 있으며 네트워크 측정은 임상 조건 전반에 걸쳐 인지 장애를 평가하는 데 도움이 될 수 있음을 보여주었다.

• Korean Journal of Radiology
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• 제24권9호
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• pp.860-870
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• 2023

Objective: The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI. Materials and Methods: This prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESS-WE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors. Results: The main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESS-WE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64-8.25] and 2.02 [95% CI: 0.32-12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19-16.75] and 1.94 [95% CI: 0.20-18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, P < 0.001). Conclusion: Preoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.

• Investigative Magnetic Resonance Imaging
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• 제13권2호
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• pp.161-170
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• 2009

목적 : 평행영상(Parallel imaging)기법의 개발로 긴 촬영시간 때문에 종종 사용되지 못하던 삼차원 영상기법이 최근 들어 환자 병을 진단하는데 새로이 사용되고 있다. 이 연구의 목적은 최근에 뇌 영상에서 개발되어 이용되고 있는 삼차원 자기공명영상을 사람의 뇌에서 짧은 시간 내에 얻을 수 있도록 2차원 평행영상 기법을 사용한 최적화 방법을 연구하는데 있다. 대상 및 방법 : 검사 장비는 3.0T 자기공명영상장치를 이용하였으며 8-채널 SENSE(sensitivity encoding) 머리 코일을 이용하였다. 팬텀 및 3명의 사람 머리에서 영상을 얻었다. 세 가지의 삼차원 영상법인 3D T1WI, 3D T2WI 및 3D FLAIR 영상 방법에 대하여 평행인자(SENSE factor)의 변화에 따른 팬텀 영상을 얻었다. 각각의 영상법에서 영상획득에 적당한 SENSE 인자를 찾기 위해 Phase encoding 방향과 Slice encoding 방향을 조합한 SENSE 인자를 변화시키면서 영상을 얻었다. 영상분석을 위하여 특정영역(ROI)를 설정한 후에 신호대 잡음비 (Signal-to-noise ratio, SNR), 감소분율(Percent Signal Reduction Rate, %R), 대조도(contrast-to-noise ratio, CNR)를 계산하였다. 결과 : 팬텀을 이용한 SENSE 인자 변화에 따른 SNR 및 %R 값의 변화 결과 3D T1WI 방법에서 SENSE 인자를 사용한 것들 중에서 SENSE 인자를 총 3인 경우 약 0.2%의 신호 감소가 나타났고 영상시간은 5분 이내였다. 3D T2WI 방법의 경우 SENSE 인자를 사용한 것들 중에서 SENSE 인자를 총 3인 경우에 약 1.0% 신호 감소가 나타났고 영상 시간은 약 5분 이내였다. 3D FLAIR 방법의 경우 SENSE 인자를 사용한 것들 중에서 SENSE 인자를 4를 사용한 경우에 약 0.2% 신호 감소가 나타났고 영상시간은 약 6분이었다. 사람을 대상으로 할 경우 3D T1W 및 3D T2W영상에서 SNR 및 CNR은 SENSE 인자를 3으로 한 경우에서 SENSE 인자를 4로 한 경우 보다 높게 나타났다. 3D FALIR 영상의 경우 CNR은 SENSE 4에서는 SENSE 3에 비하여 낮았다. 결론 : 본 연구에서는 3가지 3차원 영상법을 실제 임상적용이 가능한 시간 영역에서 SENSE 인자를 변화 시키면서 치적의 영상을 얻도록 하는 연구를 실시한 결과 SNR 감소를 최소화 하면서 영상획득 시간을 약 5분에서 6분 정도 소요되는 2차원 SENSE 인자를 찾았다. 이를 뇌 영상에 적용하였을 경우 SENSE 인자를 적용하지 않은 경우와 비교하면 신호 감소는 최소화 하면서 영상의 질은 큰 영향을 주지 않은 것으로 나타났다. 3D T1W및 3D T2W는 SENSE 인자를 3으로 3D FLAIR인자는 SENSE 인자를 4로 하는 것이 환자를 대상으로 한 뇌 영상에 적합하다고 생각된다. 앞으로는 이들 영상법이 뇌 영상뿐만 아니라 다른 영역의 영상에 적용을 위한 최적화가 필요하다고 생각된다.

• Childhood Kidney Diseases
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• 제11권2호
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• pp.212-219
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• 2007

목 적 : 소아의 급성 신우신염은 어릴수록 증상이 비특이적이어서 진단이 어렵고 신반흔이 발생할 위험이 높으나, 조기 진단 및 적절한 치료로써 신반흔의 유병률을 줄일 수 있다. 소아의 발열성요로 감염 환아에서 급성 신우신염의 조기 진단을 위한 요로계 영상 검사를 비교함으로써, 연령별 유용성에 대해 살펴보고자 하였다. 방 법 : 발열성 요로 감염으로 진단받고, 급성기에 DMSA 스캔과 신초음파 및 배뇨중 방광 요도조영술을 시행했던 총 53명(2세 미만 34명, 2세 이상 19명)을 대상으로 하여, 두 연령군 사이에 영상검사의 민감도 및 그 연관성을 관찰하였다. 결 과 : DMSA 스캔의 신피질 결손율은 2세 미만에서 23.5%로서, 2세 이상의 63.2%에 비해 유의하게 낮았다(P<0.05). DMSA 스캔의 신피질결손은 말초 혈액 백혈구 증가와 연관이 있을 뿐, 발열 기간, ESR, CRP와는 연관이 없었고, 신초음파 이상소견 및 방광 요관 역류 유무와도 유의한 연관성 이 없었다. 결 론 : 2세 미만에서는 DMSA 스캔의 민감도가 낮아서 급성 신우신염의 진단에 어려움이 있고, DMSA 스캔만으로 방광 요관 역류의 유무를 예측할 수 없으므로 배뇨성 방광 요도 조영술을 함께 시행하는 것이 필요할 것으로 사료된다.

• 감성과학
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• 제20권4호
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• pp.15-30
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• 2017

본 연구의 목적은 뇌 영상 기술을 활용한 정서 연구를 근거로 기본정서 이론을 확인하는 것이다. 이를 위해 기능적 자기공명영상(functional magnetic resonance imaging, fMRI) 연구들에 대한 메타분석을 수행했다. 기본정서 이론을 확인하기 위해 즐거움, 행복, 공포, 분노, 혐오, 슬픔의 6개 개별정서를 선정했다. 개별정서의 fMRI 자료를 수집하기 위해 최근 10년간 289편의 fMRI 연구를 조사했으며, 이중에서 69편이 포함 기준을 충족시켰다. 6개 정서에 대해서 건강한 피험자들을 대상으로 실험한 fMRI 자료를 수집했으며, Talairach 또는 MNI 표준 좌표로 보고된 연구만을 포함시켰다. Talairach와 MNI 좌표 체계간의 차이를 없애기 위해 Talairach 좌표를 기준으로 분석하였다. 활성화 가능성 추정(ALE) 기법을 이용한 GingerALE 2.3 프로그램을 사용하여 메타분석을 수행했다. 연구 결과 기본정서 이론의 관점에서 개별정서들이 일관되고 구별 가능한 국부적인 뇌 반응과 관련 된다는 것을 확인했다. 각각의 개별 정서들과 관련된 뇌 반응 영역에 대한 본 연구의 결과는 선행연구들의 결과와 대체로 일치하였다. 본 연구의 결과를 일반화에 있어서 극복해야 할 제한점을 기술하고 후속 연구에 대해 몇 가지를 제언하였다.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1875-1885
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• 2021

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. Materials and Methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. Conclusion: Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

• Korean Journal of Radiology
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• 제23권7호
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• pp.742-751
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• 2022

Objective: To assess focal mineral deposition in the globus pallidus (GP) by CT and quantitative susceptibility mapping (QSM) of MRI scans and evaluate its clinical significance, particularly cerebrovascular degeneration. Materials and Methods: This study included 105 patients (66.1 ± 13.7 years; 40 male and 65 female) who underwent both CT and MRI with available QSM data between January 2017 and December 2019. The presence of focal mineral deposition in the GP on QSM (GP_QSM) and CT (GP_CT) was assessed visually using a three-point scale. Cerebrovascular risk factors and small vessel disease (SVD) imaging markers were also assessed. The clinical and radiological findings were compared between the different grades of GP_QSM and GP_CT. The relationship between GP grades and cerebrovascular risk factors and SVD imaging markers was assessed using univariable and multivariable linear regression analyses. Results: GP_CT and GP_QSM were significantly associated (p < 0.001) but were not identical. Higher GP_CT and GP_QSM grades showed smaller gray matter (p = 0.030 and p = 0.025, respectively) and white matter (p = 0.013 and p = 0.019, respectively) volumes, as well as larger GP volumes (p < 0.001 for both). Among SVD markers, white matter hyperintensity was significantly associated with GP_CT (p = 0.006) and brain atrophy was significantly associated with GP_QSM (p = 0.032) in at univariable analysis. In multivariable analysis, the normalized volume of the GP was independently positively associated with GP_CT (p < 0.001) and GP_QSM (p = 0.002), while the normalized volume of the GM was independently negatively associated with GP_CT (p = 0.040) and GP_QSM (p = 0.035). Conclusion: Focal mineral deposition in the GP on CT and QSM might be a potential imaging marker of cerebral vascular degeneration. Both were associated with increased GP volume.