• Journal of the Korean Society of Radiology
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• v.79 no.6
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• pp.340-347
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• 2018

Purpose: To evaluate value of image subtraction for identifying hepatocellular carcinoma (HCC) capsule on gadoxetic acid-enhanced MR images. Materials and Methods: This study involved 108 patients at risk of HCC preoperatively examined using gadoxetic acid-enhanced MRI with hepatic resection between May 2015 and February 2017. We evaluated qualities of subtraction images and presence of capsular appearance on portal venous or transitional phases conventional and subtraction images. We assessed effect of capsular appearance on subtraction images on HCC. Results: After excluding 1 patient who had treated by transarterial chemoembolization prior to surgery and 33 patients with unsatisfactory subtraction image qualities, 82 focal hepatic lesions (73 HCC, 5 non-HCC malignancies, and 4 benign) from 74 patients were analyzed. Regarding detection of capsules, sensitivity, accuracy, and area under the receiver operating characteristic curve (AUC) on subtraction images were significantly higher than those on conventional images (95.4%, 89.0%, and 0.80, respectively; p < 0.001), though specificities were same (64.7%). For diagnosis of HCC, sensitivity, accuracy, and AUC on subtraction images were significantly higher than on conventional images (82.2%, 79.3%, and 0.69, respectively; p = 0.011), though specificities were identical (55.6%). Conclusion: Portal venous or transitional phase gadoxetic acid-enhanced MRI subtraction images could improve detection of HCC capsule.

• Investigative Magnetic Resonance Imaging
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• v.14 no.1
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• pp.31-40
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• 2010

Purpose : To compare the relative values of various fast breath-hold imaging sequences for superparamagnetic iron-oxide (SPIO)-enhanced hepatic MRI for the assessment of solid focal lesions with a 3T MRI unit. Materials and Methods : 102 consecutive patients with one or more solid malignant hepatic lesions were evaluated by spoiled gradient echo (GRE) sequences with three different echo times (2.4 msec [GRE_2.4], 5.8 msec [GRE_5.8], and 10 msec [GRE_10]) for $T2^*$-weighted imaging in addition to T2-weighted turbo spin echo (TSE) sequence following intravenous SPIO injection. Image qualities of the hepatic contour, vascular landmarks and artifacts were rated by two independent readers using a four-point scale. For quantitative analysis, contrast-to-noise ratio (CNR) was measured in 170 solid focal lesions larger than 1 cm (107 hepatocellular carcinomas, nine cholangiocarcinomas and 54 metastases). Results : GRE_5.8 showed the highest mean points for hepatic contour, vascular anatomy and imaging artifact presence among all of the subjected sequences (p<0.001) and was comparable (p=0.414) with GRE_10 with regard to lesion conspicuity. The mean CNRs were significantly higher (p<0.001) in the following order: GRE_10 ($24.4{\pm}14.5$), GRE_5.8 ($14.8{\pm}9.4$), TSE ($9.7{\pm}6.3$), and GRE_2.4 ($7.9{\pm}6.4$). The mean CNRs of CCCs and metastases were higher than those of HCCs for all imaging sequences (p<0.05). Conclusion : Regarding overall performances, GRE using a moderate echo time of 5.8 msec can provide the most reliable data among the various fast breath-hold SPIO-enhanced hepatic MRI sequences at 3T unit despite the lower CNR of GRE_5.8 compared to that of GRE_10.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.14-30
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• 1998

Manganese is an essential element in the body. It is mainly deposited in the liver and to a lesser degree in the basal ganglia of the brain and eliminated through the bile duct. Rapid turnover of managanese in the body makes it difficult to evaluate the manganese exposure in workers, esecially in those with irregular or intermittent exposure, like welders. Therefore, conventional biomarkers, including blood and urine manganese can provide only a limited information about the long-tern or cumulative exposure to manganese. Introduction of magnetic resonance imaging (MRI) made a progress in the assessment of manganese exposure in the medical conditions related to manganese accumulation, e. g. hepatic failure and long-term total parenteral nutrition. Manganese shortens spin-lattice(T1) relaxation time on MRI due to its paramagnetic property, resulting in high signal intensity (HSI) on T1-weighted image(T1W1) of MRI. Manganese deposition in the brain, therefore, can be visualizedas an HSI in the globus pallidus, the substantia nigra, the putamen and the pituitary. clinical and epidemiologic studies regarding the MRI findings in the cases of occupational and non-occupational manganese exposure were reviewed. relationships between HSI on T1W1 of MRI and age, gender, occupational manganese exposure, and neurological dysfunction were analysed. Relationships betwen biological exposure indices and HSI on MRE werealso reviewed. Literatures were reviewed to establish the relationships between HSI, Manganese deposition in the brain, pathologic findings, and neurological dysfunction. HSI on T1W1 of MRI reflects regional manganese deposition in the brain. This relationship enables an estimation of regional manganese deposition in the brain by analysing MR signal intensity. Manganese deposition in the brain can induce a neuronal loss in the basal ganglia but functional abnormality is supposed to be related to the cumulative exposure of manganese in the brain, use of brain MRI for the assessment of exposure in a group of workers seems to be hardly rationalized, while ti can be a useful adjunct for the evaluation of manganese exposure int he cases with suspected manganese-related health problems.

• The Journal of the Korea Contents Association
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• v.14 no.11
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• pp.558-574
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• 2014

The number of fatty liver patients is sharply growing due to the rapid increase in the incidence of metabolic syndrome, which can lead to diseases such as abdominal obesity, hypertension, diabetes, and hyperlipidemia. Early diagnosis requires examinations using magnetic resonance imaging (MRI), wherein quantitative analyses are implemented through a professional water-fat separation method in many cases, as the intensity values of the areas of interest and non-interest are considerably similar or the same. However, such separation method generates inaccurate results in high magnetic fields, where the inhomogeneity of the fields increases. To overcome the limits of such conventional fat quantification methods, this paper proposes a field map estimation method that is effective in high magnetic fields. This method generates field maps through echo images that are obtained using the existing IDEAL sequences, and considers the wrapping degree of the field maps. Then clustering is performed to separate calibration areas, the least square fits based on the region growing method schema of the separated calibration areas, and the histograms are adjusted to separate the water from the fats. In experiment results, our proposed method had a superior fat detection rate of an average of 86.4%, compared to the ideal method with an average of 61.5% and Yu's method with an average of 62.6%. In addition, it was confirmed that the proposed method had a more accurate water detection rate of 98.4% on the average than the 88.6% average of the fat saturation method.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.118-126
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• 2001

Purpose : In this study, it was investigated whether dose response relation existed or not in local radiotherapy for primary hepatocellular carcinoma. Materials and Methods : From January 1992 to March 2000, 158 patients were included in present study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Radiotherapy was given to the field including tumor with generous margin using 6, 10-MV X-ray. Mean tumor dose was $48.2{\pm}7.9\;Gy$ in daily 1.8 Gy fractions. Tumor response was based on diagnostic radiologic examinations such as CT scan, MR imaging, hepatic artery angiography at $4\~8$ weeks following completion of treatment. Statistical analysis was done to investigate the existence of dose response relationship of local radiotherapy when it was applied to the treatment of primary hepatocellular carcinoma. Results : An objective response was observed in 106 of 158 patients, giving a response rate of $67.1\%$. Statistical analysis revealed that total dose was the most significant factor in relation to tumor response when local radiotherapy was applied to the treatment of primary hepatocellular carcinoma. Only $29.2\%$ showed objective response in patients treated with dose less than 40 Gy, while $68.6\%\;and\;77.1\%$ showed major response in patients with $40\~50\;Gy$ and more than 50 Gy, respectively. Child-Pugh classification was significant factor in the development of ascites, overt radiation induced liver disease and gastroenteritis. Radiation dose was an important factor for development of radiation induced gastroduodenal ulcer. Conclusion : Present study showed the existence of dose response relationship in local radiotherapy for primary hepatocellular carcinoma. Only radiotherapy dose was a significant factor to predict the objective response. Further study is required to predict the maximal tolerance dose in consideration of liver function and non-irradiated liver volume.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.123-129
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• 2002

Purpose : The purpose of this study 띤as to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. Materials and Methods : Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from $36\~60\;Gy$ (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at $4\~8$ weeks following the completion of treatment. The acute and subacute toxicities were monitored. Results : An objective response was observed in 11 out of 17 patients, giving a response rate of $64.7\%$. The actuarial survival rate at 2 years was $21.2\%$ from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 30-CRT were gastro-duodenitis $(\geq\;grade\;2)$ in 2 patients. There were no treatment related deaths and radiation induced hepatitis. Conclusion : The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.