• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.

• 한국콘텐츠학회논문지
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• 제9권12호
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• pp.322-331
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• 2009

SPECT 장치에서 반치폭은 분해능을 평가할 수 있는 척도가 되므로, 본 연구에서는 검출기가 각각 2개와 3개가 있는 장치를 이용하여 우리나라에서 가장 많이 사용되는 7개의 필터 - Band limited, Sheep-logan, Hanning, Hamming, Low pass cosine, Parazen and Butterworth - 에 대해 세 개의 점선원으로 filter별로 MTF curve를 얻어 각각의 축방향에 따른 cut off level 과 profile 곡선을 이용하여 반치폭(FWHM)의 크기의 변화를 관찰하였다. 실험 결과 모든 filter에서 cut off level 0.4였을 때 가장 큰 반치폭의 길이가 측정되어 분해능이 가장 떨어졌고, cut off level 0.7에서 가장 높은 분해능을 보였다. MS2에서 가장 짧은 반치폭은 Butterworth filter사용시 $11.07\pm0.07mm$이었으며, MS3에서는 Hanning filter사용시 $8.44\pm0.19mm$로 나타났다.

• 한국의학물리학회지:의학물리
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• 제28권3호
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• pp.77-82
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• 2017

We proposed the objective ROC analysis method based on the setting of threshold value for evaluation of single photon emission computed tomography (SPECT) image. This proposed ROC analysis method uses the quantification computational threshold value to each signal on the SPECT image. The SPECT images for this study were acquired by using Monte Carlo n-particle extended simulation code (MCNPX, Ver. 2.6.0, Los Alamos National Laboratory, USA). The basic SPECT detectors and specific water phantom were realized in the simulation, and we could get the simulation results by the simulation operation. We tried to analyze the reconstructed images using threshold value application based objective ROC method. We can get the accuracy information of reconstructed region in the image. This proposed ROC technique can be helpful when we have to evaluate the weak signal for the NM image. In this study, the proposed threshold value based computational ROC analysis method can provide better objectivity than the conventional ROC analysis method.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.434-440
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• 2006

Objective : The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow[CBF] and cerebrovascular reserve capacity[CVRC], and to investigate the usefulness of single photon emission computed tomography [SPECT] as a prognostic factor for neurological improvement after cranioplasty. Methods : Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery[MCA] and internal carotid artery[ICA] were obtained by transcranial Doppler ultrasonography[TCD]. The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT [Group 1, n=7] and hypoactivity to acetazolamide-activated SPECT [Group 2, n=17]. These measurements were obtained two weeks prior to and two weeks after cranioplasty. Results : The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased [P<0.05]. Compared with Group 2, there was significant increase in CBF and neurological improvement after cranioplasty in Group 1. Conclusion : Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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• pp.207-212
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• 2005

Objective: Classically, single photon emission tomography is known to be the reference standard for evaluating the hemodynamic status of patients with moyamoya disease. Recently, T2-weighted perfusion magnetic resonance(MR) imaging has been found to be effective in estimating cerebral hemodynamics in moyamoya disease. We aim to assess the utility of perfusion-weighted MR imaging for evaluating hemodynamic status of moyamoya disease. Methods: The subjects were fourteen moyamoya patients(mean age: 7.21 yrs) who were admitted at our hospital between Sep. 2001 to Sep 2003. Four normal children were used for control group. Perfusion MR imaging was performed before any treatment by using a T2-weighted contrast material-enhanced technique. Relative cerebral blood volume(rCBV) and time to peak enhancement(TTP) maps were calculated. Relative ratios of rCBV and TTP in the anterior cerebral artery(ACA), middle cerebral artery(MCA) and basal ganglia were measured and compared with those of the posterior cerebral artery(PCA) in each cerebral hemispheres. Using this data, we analysed the hemodynamic aspect of pediatric moyamoya disease patients in regarding to the age, Suzuki stage, signal change in FLAIR MR imaging, and hemispheres inducing symptoms. Results: The mean rCBV ratio of ACA, MCA did not differ between normal children and moyamoya patients. However the significant TTP delay was observed at ACA, MCA territories (mean = 2.3071 sec, 1.2089 see, respectively, p < 0.0001). As the Suzuki stage of patients is advanced, rCBV ratio is decreased and TTP differences increased. Conclusion: Perfusion MR can be applied for evaluating preoperative cerebral hemodynamic status of moyamoya patients. Furthermore, perfusion MR imaging can be used for determine which hemisphere should be treated, first.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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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.

• Clinical and Experimental Pediatrics
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• 제53권4호
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• pp.603-606
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• 2010

부신생물 변연계뇌염(paraneoplastic limbic encephalitis)은 신경계의 전이가 없이 종양의 원격 작용에 의해 발생하는 질환으로 소아에서는 드물게 보고되고 있다. 저자들은 사춘기 여아에서 발생한 성숙 난소기형종에 동반된 부신생물 변연뇌염을 경험하고 보고하고자 한다. 15세 여자 환자가 신경정신증상, 기억력 저하, 경련, 의식 저하를 주소로 내원하였다. 뇌척수액 검사, 뇌 MRI는 정상이었으나, 뇌 SPECT 검사에서 양측 측두엽의 저관류가 관찰되었다. 복부 초음파와 MRI에서 좌측 난소의 낭성 종양이 발견되었다. 종양의 수술적 제거 후 성숙 난소기형종으로 확인되었으며, 종양 제거 및 면역글로불린 정맥 투여로 완전한 인지 기능의 회복을 보였다.

• 대한핵의학회지
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• 제25권1호
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• pp.68-75
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• 1991

The value of $^{99}Tc-RBC$ scintigraphy and SPECT in the diagnosis of hepatic hemangioma was evaluated in 27 patients with 38 hemangiomas and 13 patients with 15 nonhemangiomas. Twenty four (63.2%) of 38 hemangiomas were detected by planar delayed RBC imaging, whereas 30 (78.9%) hemangiomas were detected by the delayed RBC SPECT. Increase in sensitivity was noted in nodules less than 2 cm in diameter. The smallest hemangioma shown by delayed RBC SPECT was 0.9 cm in diameter. All of nonhemangiomatous lesions show normal or decreased activity in delayed blood pool images. We concluded that $^{99m}Tc-RBC$ SPECT is an accurate method for the detection of hepatic hemangioma and is more sensitive than planar imaging in depicting small lesions.

• 대한핵의학회지
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• 제30권1호
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• pp.1-14
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• 1996

Since the publication of the first bone scintiscans in 1962 three decades have elapsed. The bone scan has made great strides during this period, becoming one of the most commonly used nuclear imaging tests. In spite of the progress, however, the specificity of bone scan has remained relatively low. As the result it is a common practice to seek additional information from radiograph, CT scan and MR image, which is euphemistically termed as "image fusion or co-location." The basic reason is the inapplicability of the classical piecemeal analysis to interpreting planar and SPECT bone scans. Such analysis has its base on the observation of elemental features of morphology, which include the size, shape, contour, location, topography and internal architecture. The physiochemical profile may well also be included. Understandably, however, the miniatured images of the planar bone scan cannot provide these features in acceptable detail and the same holds true even with SPECT Images which are but sliced views of the reconstructed planar scans. Fortunately pinhole scanning has the capacity to portray both the morphological and chemical profiles of bone and joint diseases in greater detail through true magnification. The magnitude of pinhole scan resolution is practically comparable to that of radiography as far as gross anatomy is concerned. Thus, we feel strongly that pinhole scanning is a potential breakthrough of the long-lamented low specificity of bone scan. This presentation will discuss the fun-damentals, advantages and disadvantages and the most recent advances of pinhole scanning. It high-lights the actual clinical applications of pinhole scanning in relation to the diagnosis of infective and inflammatory diseases of bone and joint.

• 대한두경부종양학회지
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• 제14권2호
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• pp.175-181
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• 1998

Objectives: The authors tried to analyze the results of carotid artery sacrifice with or without preoperative carotid evaluation. Materials and Methods: Thirteen patients undergone carotid sacrifice were evaluated. Carotid balloon occlusion test (BOT) and single-photon emission computed tomography (SPECT) with technetium-99m-labeled hexamethylpropyleneamineoxime ($^{99m}Tc-HMPAO$) were used for preoperative carotid evaluation. Results: The causes of carotid artery sacrifice consisted of the neck mass involving the carotid artery, spontaneous aneurysmal rupture, and traumatic pseudoaneurysm. Five patient had postoperative neurologic complications and two of them had permanent neurologic deficits. Conclusion: The authors stress that the preoperative evaluation in carotid artery sacrifice is imperable, and the BOT with SPECT can be used in selecting the method of treatment. But since these tests cannot predict the postoperative outcome perfectly, careful perioperative care of the patients should be exercised regardless of the results of the preoperative evaluation.