• Korean Journal of Radiology
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• v.24 no.12
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• pp.1221-1231
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• 2023

Objective: To clinically validate the feasibility and accuracy of cine images acquired through the multitasking method, with no electrocardiogram gating and free-breathing, in measuring left ventricular (LV) function indices by comparing them with those acquired through the balanced steady-state free precession (bSSFP) method, with multiple breath-holds and electrocardiogram gating. Materials and Methods: Forty-three healthy volunteers (female:male, 30:13; mean age, 23.1 ± 2.3 years) and 36 patients requiring an assessment of LV function for various clinical indications (female:male, 22:14; 57.8 ± 11.3 years) were enrolled in this prospective study. Each participant underwent cardiac magnetic resonance imaging (MRI) using the multiple breath-hold bSSFP method and free-breathing multitasking method. LV function parameters were measured for both MRI methods. Image quality was assessed through subjective image quality scores (1 to 5) and calculation of the contrast-to-noise ratio (CNR) between the myocardium and blood pool. Differences between the two MRI methods were analyzed using the Bland-Altman plot, paired t-test, or Wilcoxon signed-rank test, as appropriate. Results: LV ejection fraction (LVEF) was not significantly different between the two MRI methods (P = 0.222 in healthy volunteers and P = 0.343 in patients). LV end-diastolic mass was slightly overestimated with multitasking in both healthy volunteers (multitasking vs. bSSFP, 60.5 ± 10.7 g vs. 58.0 ± 10.4 g, respectively; P < 0.001) and patients (69.4 ± 18.1 g vs. 66.8 ± 18.0 g, respectively; P = 0.003). Acceptable and comparable image quality was achieved for both MRI methods (multitasking vs. bSSFP, 4.5 ± 0.7 vs. 4.6 ± 0.6, respectively; P = 0.203). The CNR between the myocardium and blood pool showed no significant differences between the two MRI methods (18.89 ± 6.65 vs. 18.19 ± 5.83, respectively; P = 0.480). Conclusion: Multitasking-derived cine images obtained without electrocardiogram gating and breath-holding achieved similar image quality and accurate quantification of LVEF in healthy volunteers and patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.270-278
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• 2005

Objectives : This study is to understand the clinical characteristics and course of inpatient severe ADHD. Methods : This study retrospectively investigated the chief complaints, history, demographics, neuropsychologic test, psychosocial status of 63 (male 58, female 5) inpatients from a single center with severe attention deficit/hyperactivity disorder(ADHD) during January 1, 1996 to October 31, 2002. Results : The patients with inpatient severe ADHD revealed a male to female ratio of 11.6 : 1 and the average age of onset was 5.3 years(63.6 months, SD 24.3 months) . Comorbidities were noted in 56/63 $(88.9\%)$ patients with the following frequencies : comorbid conduct disorder, 35$(55.6\%)$, mental retardation (MR), 24$(38.1\%)$, mood disorder, 5$(7.9\%)$, tic and Tourette's disorder, 4$(6.4\%)$, oppositional defiant disorder, 4$(5.0\%)$. Chief complaints for admission related to ADHD in 23$(36.5\%)$ patients while 37$(58.7\%)$ patients admitted due to symptoms associated to conduct disorder (CD). The mean onset age of comorbid delinquency was 9.0 years (108.2 months, SD28.8 months), and the average interval between onsets of ADHD and delinquency was 3.6 years (42.9 months, SD32.0 months). Patients who showed early delinquency tended to have an earlier onset of ADHD (p<0.05). Conclusion : The demographics, natural course, and psychosocial factors of hospitalized ADHD patients were similar to prior studies of ADHD in the general population. The onset of age was 5.3 years, and the onset of comorbid delinquency was 9.0 years. The earlier symptoms of ADHD manifested, the earlier delinquency appeared. Most patients were admitted due to chief complaints related to CD. Comorbidities, most of which were CD, were seen in $88.9\%$ of the patients.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.985-991
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• 2001

Objectives : The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. Material and Methods: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M : F=8 : 8, mean age : 43.7 years) and 7 children(M : F=5 : 2, mean age : 10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. Results : The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.2
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• pp.52-61
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• 2009

Objectives : The aim of this study was to assess health-related quality of life and evaluate the risk factors affecting severity of menopausal symptoms in early and late postmenopausal women based on the stages of reproductive aging workshop(STRAW) paradigm. Methods : This cross-sectional study examined 497 Korean postmenopausal women aged 41-59 years in Seoul and Gyeonggi province. We divided subjects into early postmenopause group and late postmenopause group. Menopause Rating Scale(MRS) was used to measure the quality of life. MRS scores, sociodemographic variables, smoking, alcohol use, age at menopause, and risk factors such as attitude to menopause, depression, history of premenstrual dysphoric disorder were compared between early and late postmenopause groups. Multiple regression analysis was performed in each group to assess the independent contribution of several variables. Results : Early postmenopause group showed significantly higher MRS scores, more negative attitude toward menopause, higher scores of depressive symptoms than late postmenopause group. Moderate to very severe hot flush group showed significantly, more negative attitude toward menopause, higher score of depressive symptoms, and higher MRS scores than none to mild hot flush groups. Depressive symptoms and attitude toward menopause contributed to the severity of menopausal symptom in both early and late postmenopause groups. Chronological age, age at menopause, history of PMDD contributed to severity of menopausal symptoms in early postmenopause group while marital status and occupation contributed in late postmenopause group. Conclusion : Health-related quality of life in postmenopause women was significantly lower in early postmenopause group than the late. Attitude toward menopause and depressive symptoms contributed significantly to quality of life in both early and late postmenopause groups but other variables contributed differently in each group. Further studies on clinical samples of postmenopausal women in order to confirm quality of life and its risk factor are needed to be done.

• Radiation Oncology Journal
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• v.15 no.3
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• pp.215-224
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• 1997

Purpose : Stereotactic radiosurgery with external beam irradiation successfully obliterates carefully selected intracranial arteriovenous malformation (AVM) . We Present clinical and radiological long term results after treatment with a single high dose irradiation using a linear accelerator. Materials and Methods : Rrom January 1991 to June 1994, fifteen patients with intracranial AVM were treated in our hospital with the stereotactic radiosurgery using a linear accelerator. The radiation was delivered using a 6 MV linear accelerator. The prescribed doses at the isocenter varied from 1800 to 2500cGy (median : 2000cGy) and were given as a sin91e fraction. The radiation doses at the periphery of the lesion typically corresponded to the 80-90% isodose line. In 14 patients, complete clinical and/or radiological follow-up examination were available. Results : Angiography was available in 13 patients with a follow-up Period from 18 months to 27 months. Of 13 patients, the overall complete obliteration rate was 92.3% (12 patients). This incidence did not correlate with lesion size. Seizure, headache and progressive neurologic deficit were complete recovered. One Patient experienced hemorrhage at 2 months after treatment. One patient developed radiation induced brain edema in the white matter surrounding nidus at 16 months after treatment and showed complete resolution of the edema in MR image obtained at 27 months after treatment. After a follow-up period of up to 6 years, no radiation induced severe late complications occurred. Conclusion : We conclude that stereotactic radiosurgery using a linear accelerator is an effective and safe therapy for symptomatic and surgically inaccessible intracranial AVMs and the results compare favorably to the more expensive and elaborate systems that are currently available for stereotactic radiosurgery.

• Advances in pediatric surgery
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• v.6 no.2
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• pp.106-123
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• 2000

The purpose of the survey was to clarify the clinical features and management of the anorectal malformations (ARM) in Korea. Twenty-seven members of the Korean Association of Pediatric Surgeons were surveyed. The members completed a case registration form for each patient during the two years period of 1996-1997, and a questionnaire that contained their management preferences for primary and complicated patients. Twenty-four members of the 22 institutions registered 295 cases of the ARM, and 27 out of 34 members (77.1 %) responded to the questionnaire. The patients were classified by the Wingspread classification of ARM(1984). The case registration form was a modification of Wingspread workshop for the postoperative assessment and case registration. The male to female ratio was 1.7 : 1. The average number of patients per surgeon was 6.1 cases per year. Prematurity(< 36 weeks) was present in 1.9 % of cases and low birth weight (< 2.6 Kg) in 12.1 %. Among 187 male patients, 62 were high(H) type, 29 intermediate(l) type, 88 low(L), and 8 unclassified. In female, there were 2 cases of cloacal anomalies(C), 4 H type, 30 I type, 66 L type and 6 unclass ified. For male, 87.9 % of H and I type were operated by the Pena procedure, but only 7.9 % in L types. In female, all of C, H and I types, and 40.9 % of L type were done by the Pena procedure. One case expired (MR; 0.003%) as a result of surgical complication. Over-all complication rate was 12.5 %. Among 6 cases of reoperation, 4 were failed Pena procedures. Among 140 colostomies sigmoid colon was utilized in 75.7%, and loop colostomy was commonly used. Ten surgeons prefered primary maturation of the stoma. In conclusion, posterior sagittal anorectoplasty is popular for high types of ARM in this country, but considerable number of patients are still suffering from failed operations. For better understanding and analysis, necessity of prospective study by new classification was discussed.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.399-406
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• 2007

Background: Ischemia-reperfusion injury related to unsuccessful myocardial protection affects postoperative ventricular function and mortality during open-heart surgery. We prospectively compared the effects of administration of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia (CBC) on myocardial protection and clinical outcome in patients undergoing mitral valve surgery. Material and Method: Seventy patients with mitral regurgitation (MR) undergoing mitral valve surgery were randomly divided into the HTK group (n=31) and the CBC group (n=31 ): eight patients were excluded. Perioperative hemodynamics, cardiac medications, pacing, postoperative outcomes and complications were recorded during the hospital stay. All patients received follow-up for at least 6 months postoperatively for morbidity and mortality. Resuか: There were no significant differences in the hemodynamics between the groups during the study period, except for the mean pulmonary artery pressure (MPAP), PCWP and CVP that were lower in the HTK group at 15 min after weaning of CBP. There were no differences for inotropic support and pacing during the 12 hrs postoperatively between the groups. CK-MB values on day 1 and day 2 were $77{\pm}54$ and $41{\pm}23$ for the HTK group and $70{\pm}69$ and $44{\pm}34$ for the CBC group, respectively (p=NS). Postoperative clinical outcomes were similar in both groups for at least 6 months during the follow-up period. Conclusion: These results suggest that the use of HTK solution is as safe as cold blood cardioplegia in terms of myocardial protection.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.264-273
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• 2002

Purpose : Three-dimensional radiation dosimetry using magnetic resonance imaging of polymer gel was recently introduced. This dosimetry system is based on radiation induced chain polymerization of acrylic monomers in a muscle equivalent gel and provide accurate 3 dimensional dose distribution. We planned this study to evaluate the clinical value of this 3-dimensional dosimetry. Materials and Methods: The polymer gel poured into a cylindrical glass flask and a spherical glass flask. The cylindrical test tubes were for dose response evaluation and the spherical flasks, which is comparable to the human head, were for isodose curves. T2 maps from MR images were calculated using software, IDL. Dose distributions have been displayed for dosimetry. The same spherical flask of gel and the same irradiation technique was used for film and TLD dosimetry and compared with each other. Results : The R2 of the gel respond linearly with radiation doses in the range of 2 to 15 Gy. The repeated dosimetry of spherical gel showed the same isodose curves. These isodose curves were identical to dose distributions from treatment planning system especially high dose range. In addition, the gel dosimetry system showed comparable or superior results with the film and TLD dosimetry. Conclusion : The 3-dimensional dosimetry for conformal radiation therapy using MRI of polymer gal showed stable and accurate results. Although more studies are needed for convenient clinical application, it appears to be a useful tool for conformal radiation therapy.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.238-244
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• 2003

Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.161-170
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• 2009

Purpose : A parallel imaging method provides us to improve temporal resolution to obtain three-dimensional (3D) MR images. The objective of this study was to optimize three 3D MRI techniques by adjusting 2D SESNE factors of the parallel imaging method in phantom and human brain. Materials and Methods : With a 3 Tesla MRI system and an 8-channel phase-array sensitivity-encoding (SENSE) coil, three 3D MRI techniques of 3D T1-weighted imaging (3D T1WI), 3D T2-weighted imaging (3D T2WI) and 3D fluid attenuated inversion recovery (3D FLAIR) imaging were optimized with adjusting SESNE factors in a water phantom and three human brains. The 2D SENSE factor was applied on the phase-encoding and the slice-encoding directions. Signal-to-noise ratio(SNR), percent signal reduction rate(%R), and contrast-to-noise ratio(CNR) were calculated by using signal intensities obtained in specific regions-of-interest (ROI). Results : In the phantom study, SENSE factor = 3 was provided in 0.2% reduction of signals against without using SENSE with imaging within 5 minutes for 3D T1WI. SENSE factor = 2 was provided in 0.98% signal reduction against without using SENSE with imaging within 5 minutes for 3D T2WI. SENSE factor = 4 was provided in 0.2% signal reduction against without using SENSE with imaging around 6 minutes for 3D FLAIR. In the human brain study, SNR and CNR were higher with SENSE factors = 3 than 4 for all three imaging techniques. Conclusion : This study was performed to optimize 2D SENSE factors in the three 3D MRI techniques that can be scanned in clinical time limitations with minimizing SNR reductions. Without compromising SNR and CNR, the optimum 2D SENSE factors were 3 and 4, yielding the scan time of about 5 to 6 minutes. Further studies are necessary to optimize 3D MRI techniques in other areas in human body.