• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.445-450
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• 2024

Gastric metastasis (GM) from cervical cancer is extremely rare, and only a few cases have been reported in the English literature. Gastric-type mucinous adenocarcinomas (GAS) of the uterine cervix are rare. GAS is an aggressive cancer commonly found in advanced stages; however, GM has not been reported. This study presents a rare case of GM from GAS of the uterine cervix in a 61-year-old female and describes the radiological findings of both the GM and cervical mucinous adenocarcinoma. GM appeared as a poor enhancing submucosal mass. The cervical mucinous adenocarcinoma appeared as an infiltrating mass with poor contrast enhancement. It exhibited mildly high and low signal intensities on the diffusion-weighted image and apparent diffusion coefficient map, respectively. This case is extremely rare and challenging to diagnose; however, if cervical cancer is an human papillomavirus-independent GAS type and a submucosal lesion is found in the stomach, the possibility of metastasis with a pattern similar to our case could be considered.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.381-393
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• 2024

Purpose Metabolic abnormalities in hepatic encephalopathy (HE) cause brain edema or demyelinating disease, resulting in symmetric regional cerebral edema (SRCE) on MRI. This study aimed to investigate the usefulness of the clustering analysis of SRCE in predicting the development of brain failure. Materials and Methods MR findings and clinical data of 98 consecutive patients with HE were retrospectively analyzed. The correlation between the 12 regions of SRCE was calculated using the phi (φ) coefficient, and the pattern was classified using hierarchical clustering using the φ² distance measure and Ward's method. The classified patterns of SRCE were correlated with clinical parameters such as the model for end-stage liver disease (MELD) score and HE grade. Results Significant associations were found between 22 pairs of regions of interest, including the red nucleus and corpus callosum (φ = 0.81, p < 0.001), crus cerebri and red nucleus (φ = 0.72, p < 0.001), and red nucleus and dentate nucleus (φ = 0.66, p < 0.001). After hierarchical clustering, 24 cases were classified into Group I, 35 into Group II, and 39 into Group III. Group III had a higher MELD score (p = 0.04) and HE grade (p = 0.002) than Group I. Conclusion Our study demonstrates that the SRCE patterns can be useful in predicting hepatic preservation and the occurrence of cerebral failure in HE.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.184-196
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• 2024

Purpose We investigated potentially promising imaging findings and their combinations in the evaluation of cognitive decline. Materials and Methods This retrospective study included 138 patients with subjective cognitive impairments, who underwent brain MRI. We classified the same group of patients into Alzheimer's disease (AD) and non-AD groups, based on the neuropsychiatric evaluation. We analyzed imaging findings, including white matter hyperintensity (WMH) and cerebral microbleeds (CMBs), using the Kruskal-Wallis test for group comparison, and receiver operating characteristic (ROC) curve analysis for assessing the diagnostic performance of imaging findings. Results CMBs in the lobar or deep locations demonstrated higher prevalence in the patients with AD compared to those in the non-AD group. The presence of lobar CMBs combined with periventricular WMH (area under the ROC curve [AUC] = 0.702 [95% confidence interval: 0.599-0.806], p < 0.001) showed the highest performance in differentiation of AD from non-AD group. Conclusion Combinations of imaging findings can serve as useful additive diagnostic tools in the assessment of cognitive decline.

• Journal of the Korean Magnetics Society
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• v.26 no.6
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• pp.219-225
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• 2016

In this study, for assessment of degenerative knee joint cartilage disease we acquired images by fat suppressed 3D spoiled gradient recalled (SPGR) and fat suppressed 3D $T2^*$ weighted imaging techniques. To do a quantitative evaluation, the knee joint cartilage was divided into medial femoral cartilage (MFC), medial tibial cartilage (MTC), lateral femoral cartilage (LFC), lateral femoral cartilage (LFC) and patella cartilage (Pat) to measure their respective signal intensity values, signal-to-noise ratio, and contrast-to-noise ratio. As for the measured values, statistical significance between two techniques was verified by using Mann-Whitney U-Test. To do a qualitative evaluation, two radiologists have examined images by techniques after which image artifact, cartilage surface, tissue contrast, and depiction of lesion distinguishing were evaluated based on 4-point scaling (1: bad, 2: appropriate, 3: good, 4: excellent), and based on the result, statistical significance was verified by using Kappa-value Test. 3.0T MR system and HD T/R 8ch knee array coil were used to acquire images. As a result of a quantitative analysis, based on SNR values measured by using two imaging techniques, MFC, LFC, LTC, and Pat showed statistical significance (p < 0.05), but MTC did not (p > 0.05). As a result of verifying statistical significance for measured CNR value, MFC, LFC, and Pat showed statistical significance (p < 0.05), while MTC and LTC did not show statistical significance (p > 0.05). As a result of a qualitative analysis, by comparing mean values for evaluated image items, 3D $T2^*$ weighted Image has indicated a slightly higher value. As for conformance verification between the two observers by using Kappa-value test, all evaluated items have indicated statistically significant results (p < 0.05). 3D $T2^*$ weighted technique holds a clinical value equal to or superior to 3D SPGR technique with respect to evaluating images, such as distinguishing knee joint cartilages, comparing nearby tissues contrast, and distinguishing lesions.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1066-1079
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• 2023

Purpose Distinguishing intradural extramedullary (IDEM) spinal ependymoma from myxopapillary ependymoma is challenging due to the location of IDEM spinal ependymoma. This study aimed to investigate the utility of clinical and MR imaging features for differentiating between IDEM spinal and myxopapillary ependymomas. Materials and Methods We compared tumor size, longitudinal/axial location, enhancement degree/pattern, tumor margin, signal intensity (SI) of the tumor on T2-weighted images and T1-weighted image (T1WI), increased cerebrospinal fluid (CSF) SI caudal to the tumor on T1WI, and CSF dissemination of pathologically confirmed 12 IDEM spinal and 10 myxopapillary ependymomas. Furthermore, classification and regression tree (CART) was performed to identify the clinical and MR features for differentiating between IDEM spinal and myxopapillary ependymomas. Results Patients with IDEM spinal ependymomas were older than those with myxopapillary ependymomas (48 years vs. 29.5 years, p < 0.05). A high SI of the tumor on T1W1 was more frequently observed in IDEM spinal ependymomas than in myxopapillary ependymomas (p = 0.02). Conversely, myxopapillary ependymomas show CSF dissemination. Increased CSF SI caudal to the tumor on T1WI was observed more frequently in myxopapillary ependymomas than in IDEM spinal ependymomas (p < 0.05). Dissemination to the CSF space and increased CSF SI caudal to the tumor on T1WI were the most important variables in CART analysis. Conclusion Clinical and radiological variables may help differentiate between IDEM spinal and myxopapillary ependymomas.

• Journal of the Korean Society of Radiology
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• v.84 no.1
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• pp.226-239
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• 2023

Purpose To compare the sensitivities of T2-weighted image (T2WI) and susceptibility-weighted imaging (SWI) in detecting cerebral arteriovenous fistula (AVF), cerebral arteriovenous malformation (AVM), and carotid-cavernous sinus fistula (CCF), and to qualitatively evaluate single-echo SWI (s-SWI) and multi-echo SWI (m-SWI) in characterizing vascular lesions. Materials and Methods From January 2016 to December 2021, cerebral angiography-proven lesions were recruited. The sensitivities of T2WI and SWI in detecting vascular lesions were compared using McNemar's test. Qualitative evaluations of s-SWI and m-SWI were categorized to be of poor, average, or good quality and compared using Fisher's exact test. Results A total of 24 patients (mean age: 61 years, 12 female, and 12 male) were enrolled. Twenty patients underwent s-SWI or m-SWI, and four patients underwent both. AVF, AVM, and CCF were diagnosed in 10, 11, and 3 patients, respectively. SWI demonstrated higher sensitivity compared to that of T2WI (82.1% vs. 53.6%, p = 0.013). m-SWI showed better image quality compared to that of s-SWI (good quality, 83.3% vs. 25.0%, p = 0.009). Conclusion SWI demonstrated a higher sensitivity for detecting cerebral arteriovenous shunts compared to that of T2WI. m-SWI exhibited better image quality compared to that of s-SWI in characterizing vascular lesions.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.177-181
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• 2002

Background: Follow-up studies have shown that although outcomes have improved substantially over time, results of the Fontan operation and its modifications remain suboptimal. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus early and midterm change of internal diameter of PTFE conduit. Material and Method: Between April 1997 and July 2000 were reviewed. Twelve patients (M:6, F:6, mean age 42.04 $\pm$ 12.43months, mean body weight 13.80$\pm$ 1.94kg) underwent extracardiac conduit Fontan operation with expanded PTFE graft. Mean cardiopulmonary bypass time was 109.7$\pm$26.99minute and mean operation time was 455$\pm$89.51minute. Intraoperative fenestration was performed in 10 patients. The aortic cross clamping was not performed in all patients. Result: There was no early deaths and no postoperative dysrhythmia. Postoperative protein losing enteropathy and prolonged pleural effusion occurred in 1(8.3%) and 4 patients(33.3%). Conduit patency was evaluated by magnetic resonance imaging studies. A 9.84$\pm$3.84% mean reduction in conduit internal diameter and there was no statistical correlation between the change of internal diameter of conduit and the postoperative duration after partial correlation analysis(r=0.019, p=0.955). Conclusion: These results demonstrate that the extracardiac conduit Fontan operation provies good early and midterm results and may reduce the prevalence of late arrhythmia. And there is no correlation between the change of internal diameter of conduit and the postoperative duration after extracardiac conduit Fontan operation with the expanded PTFE graft conduit.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.191-197
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• 2008

Purpose: To evaluate the postoperative magnetic resonance image (MRI) findings of anterior cruciate ligament (ACL) reconstructed with a tension load technique using auto-Achilles tendon, and to compare the results with knees with a native ACL. Materials and Methods: We evaluated 21 postoperative MRI scan of 21 patients (group A) who had undergone ACL reconstruction between January 1995 and November 1996. The control group (group B) consisted of 50 patients whose meniscus tear had been operated by arthroscopy and whose ACL was intact. We measured the orientation of the graft in the sagittal and coronal planes and compared it with that of the native ACL. Results: The mean sagittal angle of the ACL angle in group A ($55.7{\pm}5.6^{\circ}$, range $47.2{\sim}68.8^{\circ}$) was statistically lesser than group B ($58.7{\pm}3.8^{\circ}$, range $50.4{\sim}67.5^{\circ}$) (p=0.036). But there was no statistically significant difference between the two groups with regard to the mean ACL-Blumensaat line angle (group A: $8.1^{\circ}{\pm}4.9^{\circ}$, range $1.7^{\circ}{\sim}22.0^{\circ}$, group B: $8.6^{\circ}{\pm}3.6^{\circ}$, range $2.6^{\circ}-18.1^{\circ}$) and the mean coronal angle of the ACL (group A: $64.9^{\circ}{\pm}9.1^{\circ}$, range $46.9^{\circ}{\sim}76.4^{\circ}$, group B: $65.9^{\circ}{\pm}4.4^{\circ}$, range $57.7^{\circ}{\sim}75.2^{\circ}$)(p=0.88, p= 0.62). In the sagittal plane, the mean center of tibial insertion of the ACL graft in group A ($31.9{\pm}7.1%$, range 22.4-47.9%) was positioned more anteriorly than group B ($37.0{\pm}4.9%$, range $18.5{\sim}44.7%$)(p=0.005). But in the coronal plane, there was no statistically significant difference between the two groups(group A: $46.3{\pm}2.8%$, range $42.1{\sim}52.5%$, group B: $45.7{\pm}2.8%$, range $41.0{\sim}49.1%$)(p=0.392). Conclusion: We performed an ACL reconstruction with the tension load technique using auto-Achilles tendon and we found that the graft orientation in MRI was as good as that of the native ACL.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.179-186
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• 2016

Purpose : To figure out if the treatment plan for rectum, bladder and prostate that have a lot of interfraction errors satisfies dosimetric limits without adaptive plan by analyzing MR image. Materials and Methods : This study was based on 5 prostate cancer patients who had IMRT(total dose: 70Gy) Using ViewRay MRIdian System(ViewRay, ViewRay Inc., Cleveland, OH, USA) The treatment plans were made on the same CT images to compare with the plan quality according to adaptive plan, and the Eclipse(Ver 10.0.42, Varian, USA) was used. After registrate the 5 treatment MR images to the CT images for treatment plan to analyze the interfraction changes of organ, we measured the dose volume histogram and the changes of the absolute volume for each organ by appling the first treatment plan to each image. Over 5 fractions, the total dose for PTV was $V_{36.25}$ Gy $${\geq_-}$$ 95%. To confirm that the prescription dose satisfies the SBRT dose limit for prostate, we measured $V_{100%}$, $V_{95%}$, $V_{90%}$ for CTV and $V_{100%}$, $V_{90%}$, $V_{80%}$ $V_{50%}$ of rectum and bladder. Results : All dose average value of CTV, rectum and bladder satisfied dose limit, but there was a case that exceeded dose limit more than one after analyzing the each image of treatment. After measuring the changes of absolute volume comparing the MR image of the first treatment plan with the one of the interfraction treatment, the difference values were maximum 1.72 times at rectum and maximum 2.0 times at bladder. In case of rectum, the expected values were planned under the dose limit, on average, $V_{100%}=0.32%$, $V_{90%}=3.33%$, $V_{80%}=7.71%$, $V_{50%}=23.55%$ in the first treatment plan. In case of rectum, the average of absolute volume in first plan was 117.9 cc. However, the average of really treated volume was 79.2 cc. In case of CTV, the 100% prescription dose area didn't satisfy even though the margin for PTV was 5 mm because of the variation of rectal and bladder volume. Conclusion : There was no case that the value from average of five fractions is over the dosimetric limits. However, dosimetric errors of rectum and bladder in each fraction was significant. Therefore, the precise delivery is needed in case of prostate SBRT. The real-time tracking and adaptive plan is necessary to meet the precision delivery.

• The Korean Journal of Nuclear Medicine
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• v.32 no.5
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• pp.414-424
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• 1998

Purpose: Cross-modality coregistration of positron emission tomography (PET) and magnetic resonance imaging (MR) could enhance the clinical information. In this study we propose a refined technique to improve the robustness of registration, and to implement more realistic visualization of the coregistered images. Materials and Methods: Using the sinogram of PET emission scan, we extracted the robust head boundary and used boundary-enhanced PET to coregister PET with MR. The pixels having 10% of maximum pixel value were considered as the boundary of sinogram. Boundary pixel values were exchanged with maximum value of sinogram. One hundred eighty boundary points were extracted at intervals of about 2 degree using simple threshold method from each slice of MR images. Best affined transformation between the two point sets was performed using least square fitting which should minimize the sum of Euclidean distance between the point sets. We reduced calculation time using pre-defined distance map. Finally we developed an automatic coregistration program using this boundary detection and surface matching technique. We designed a new weighted normalization technique to display the coregistered PET and MR images simultaneously. Results: Using our newly developed method, robust extraction of head boundary was possible and spatial registration was successfully performed. Mean displacement error was less than 2.0 mm. In visualization of coregistered images using weighted normalization method, structures shown in MR image could be realistically represented. Conclusion: Our refined technique could practically enhance the performance of automated three dimensional coregistration.