• Journal of Yeungnam Medical Science
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• v.30 no.1
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• pp.25-30
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• 2013

Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia ($Na^+$ 98 mEq/L), hypokalemia ($K^+$ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.1
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• pp.95-102
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• 2016

Objectives To investigate correlation between slip percentage (SP) of spondylolisthesis and cross-sectional area (CSA) of lumbar paraspinal muscles; psoas major (PM), multifidus (MU) and erector spinae (ES). Methods A retrospective study was carried out in 120 spondylolisthesis patients who had visited the Spine center of Kyung Hee University Hospital at Gangdong and had taken lumbar MRI. CSA of lumbar paraspinal muscles was measured from axial T2-weighted MRI and divided by CSA of vertebral body to avoid weight's influence. SP was also measured from sagittal MRI. Results SP increase has significant correlation with decreased CSA-MU (r=0.37, p<0.01) and increased CSA-ES (r=0.19, p<0.05). There was no significant correlation between SP and CSA-PM. Conclusions MU atrophy and ES hypertrophy have significant correlation with SP of spondylolisthesis. CSA of lumbar paraspinal muscles can be a risk factor of progression of spondylolisthesis and compensation for the instability.

• Journal of The Korean Society of Clinical Toxicology
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• v.11 no.1
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• pp.41-45
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• 2013

Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.

• The KIPS Transactions:PartB
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• v.10B no.3
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• pp.339-346
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• 2003

In this paper, we propose a new method in which interpolation images are created by using a small number of axiai T2-weighted images instead of using many sectional images for 3D visualization of brain MR images. For image Interpolation, an important part of this process, we first segment a region of interest (ROI) that we wish to apply 3D reconstruction and extract the boundaries of segmented ROIs and MBR information. After the image size of interpolation layer is determined according to the changing rate of MBR size between top slice and bottom slice of segmented ROI, we find the corresponding pixels in segmented ROI images. Then we calculate a pixel's intensity of interpolation image by assigning to each pixel intensity weights detected by cube interpolation method. Finally, 3D reconstruction is accomplished by exploiting feature points and 3D voxels in the created interpolation images.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.200-206
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• 2018

Background: The purpose of this study was to assess the relevance of preoperative magnetic resonance imaging (MRI) evaluation by occupation ratio (OR) at maximum diameter of supraspinatus muscle. Methods: Patients from the Inje University Sanggye Paik Hospital who received rotator cuff repair and underwent pre- and postoperative MRI were selected as subjects of this study. On T1-weighted MRIs, OR of fat and muscle at Y-shaped view, OR at a location on supraspinatus muscle where its diameter was maximum on coronal view, and pre- and postoperative Goutallier Classification and changes in the tangent sign were measured. Statistical significance of postoperative OR was assessed regarding time from symptom onset to surgery, size of rotator cuff tear, preoperative OR, and the difference between ORs measured at maximum diameter of supraspinatus muscle and Y-shaped view. Results: Preoperative OR at Y-shaped view was $52.28{\pm}8.57$ (32.5-65.3). Preoperative OR difference between maximum diameter and Y-shaped view was $13.76{\pm}10.51$ (2.38-42.04), and Pearson correlation coefficient was 0.604 (p=0.001). Postoperative OR at Y-shaped view was $63.77{\pm}9.35$ (37.3-76.1). Pearson correlation coefficient of pre- and postoperative Goutallier Classification was -0.579 (p=0.002) and Pearson correlation coefficient of the postoperative difference between ORs measured at maximum diameter of supraspinatus muscle and Y-shaped view was -0.386 (p=0.047). Conclusions: Fatty degeneration of supraspinatus muscle in rotator cuff tear patients should be evaluated not only in the conventional Y-shaped view, but also at location of maximum diameter of supraspinatus muscle to establish patients' therapeutic plan.

• Clinical Pain
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• v.19 no.1
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• pp.54-58
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• 2020

Skeletal muscle metastasis of gastric cancer is extremely rare and is associated with various symptoms. Here, we report on a 60-year-old woman with right hip pain after excessive walking. Two years earlier, the patient had been treated for advanced gastric cancer (surgery, adjuvant chemotherapy). Upon magnetic resonance imaging, diffuse muscle swelling and high signal intensity were observed in T2-weighted images of the right hip muscle. However, the FDG uptake in the right gluteal muscles was not obviously increased. Pathological examination of muscle biopsy revealed metastatic adenocarcinoma of stomach origin. The patient was treated with chemotherapy, and the swelling and pain in the right hip are progressively improving.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1021-1033
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• 2021

Objective: To assess the expression of vascular normalization genes in different molecular subtypes of breast cancer and to determine whether molecular subtypes with a higher vascular normalization gene expression can be identified using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI). Materials and Methods: This prospective study evaluated 306 female (mean age ± standard deviation, 50 ± 10 years), recruited between January 2014 and August 2017, who had de novo breast cancer larger than 1 cm in diameter (308 tumors). DCE MRI followed by IVIM DWI studies using 11 different b-values (0 to 1200 s/mm²) were performed on a 1.5T MRI system. The Tofts model and segmented biexponential IVIM analysis were used. For each tumor, the molecular subtype (according to six [I-VI] subtypes and PAM50 subtypes), expression profile of genes for vascular normalization, pericytes, and normal vascular signatures were determined using freshly frozen tissue. Statistical associations between imaging parameters and molecular subtypes were examined using logistic regression or linear regression with a significance level of p = 0.05. Results: Breast cancer subtypes III and VI and PAM50 subtypes luminal A and normal-like exhibited a higher expression of genes for vascular normalization, pericyte markers, and normal vessel function signature (p < 0.001 for all) compared to other subtypes. Subtypes III and VI and PAM50 subtypes luminal A and normal-like, versus the remaining subtypes, showed significant associations with K^trans, k_ep, v_p, and IAUGC_BN90 on DEC MRI, with relatively smaller values in the former. The subtype grouping was significantly associated with D, with relatively less restricted diffusion in subtypes III and VI and PAM50 subtypes luminal A and normal-like. Conclusion: DCE MRI and IVIM parameters may identify molecular subtypes of breast cancers with a different vascular normalization gene expression.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1342-1345
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• 2008

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare white matter disorder, first described in the early 1990s. The brain in patients with MLC appears swollen on MRI, with diffuse white matter abnormalities; in addition, there is an invariable presence of subcortical cysts, primarily in the anterior temporal region sparing the deep white matter, basal ganglia, thalami, and cerebellum. Patients with MLC present with macrocephaly and neurological abnormalities such as motor deterioration, ataxia, spasticity, and cognitive deficits. We report a twenty-month-old boy who presented with seizures and macrocephaly, delay in development, and abnormal brain MRI findings compatible with the diagnosis of MLC. The brain MRI revealed bilateral hypersignal intense subcortical white matter regions in the frontal, temporal, and parietal lobes on T2-weighted images, which were not yet associated with cystic changes. During follow-up, the frequency of seizures decreased after anticonvulsant medication was started, but the head circumference remained above the 97th percentile, and the patient continued to have developmental delay.

• Journal of the Korean Society of Radiology
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• v.81 no.1
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• pp.190-196
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• 2020

Xanthogranulomatous inflammation is a rare inflammatory reaction, characterized by lipid-laden macrophages, known as xanthomas, in histopathologic examination. Aggressive xanthogranulomatous inflammation often manifests as local infiltration but does not affect distant organs unless combined with rare systemic diseases. We report a case of focal xanthogranulomatous pyelonephritis (XGP) associated with severe xanthogranulomatous cholecystitis. Focal XGP was suspected in radiologic examination that showed a cystic lesion with an infiltrative margin, which were surgically resected and confirmed in pathologic examination. To our knowledge, this is the first report of focal xanthogranulomatous pyelonephritis associated with xanthogranulomatous cholecystitis. Moreover, we found peripheral hypointensity around the cystic lesion in the T2-weighted image, probably reflecting hemorrhage and fibrosis of the xanthogranulomatous inflammation.

• Progress in Medical Physics
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• v.25 no.3
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• pp.176-184
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• 2014

In this study, we compared dose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans were performed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord and other normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.