• Journal of Chest Surgery
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• v.36 no.10
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• pp.772-775
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• 2003

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as ‘Moyamoya vessels’. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.176-179
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• 2004

A 30 year-old female patient was admitted for dizziness and palpitation. Pulsation of the both upper extremities and both common carotid arteries were absent. Innominate artery and both common carotid arteries were severely narrowed and both subclavian arteries were completely obstructed on aortogram. The patient was diagnosed as tvue Ⅰ Takayasu's arteritis, and operation was peformed to increase blood flow to the brain and both upper extremities. Ascending aorta, both carotid arteries, both subclavian arteries, and both axillary arteries were exposed by four separate incision, and we performed an aorto-bicarotid-biaxillary bypass with Hemashield graft. Previous dizziness and palpation were disappeared after the operation.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.96-103
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• 1998

Purpose : To assess the clinical utility of turbo contrast-enhanced magnetic resonance angiography(CE MRA) in the evaluation of the aortic arch and its major branches and to compare the image quality of CE MRA among different coils used. Materials and Methods : Turbo three-phase dynamic CE MRA encompassing aortic arch and its major branches was prospectively performed after manual bolus IV injection of contrast material in 29 patients with suspected cerebrovascular diseases at 1.0T MR unit. the raw data were obtained with 3-D FISH sequence (TR 5.4ms, TE 2.3ms, flip angle 30, slab thickness 80nm, effective slice thickness 4.0mm, matrix size $100{\times}256$, FOV 280mm). Total data acquisition time was 4. to 60 seconds. We subjectively evaluated the imge quality with three-rating scheme : "good" for unequivocal normal finding, "fair" for relatively satisfactory quality to diagnose 'normal' despite intravascular low signal, and "poor" for equivocal diagnosis or non-visualization of the origin or segment of the vessels due to low signal or artifacts which needs catheter angiography. At the level of the carotid bifurcation, it was compared with conventional 2D-TOF MRA image. Overall image quality was also compared visually and quantitatively by measuring signal-to-noise ratios (SNRs) of the ascending aorta, the innominate artery and both common carotid arteries among the three different coils used(CP body array(n=12), CP neck array(n=9), and head-and-neck(n=8). Results : Demonstration of the aortic arch and its major branches was rated as "good" in 55% (16/29) and "fair" in 34%(10/29). At the level of the carotid bifurcation, image quality of turbo CE MRA was same as or better than conventional 2D-TOF MRA in 65% (17/26). Overall image quality and SNR were significantlygreater with CP body array coil than with CP neck array or head-and-neck coil. Conclusions : Turbo CE MRA can be used as a screening exam in the evaluation of the major branches of the aortic arch from their origin to the skull base. Overall imagequality appears to be better with CP body array coil than with CP neck array coil or head-and-neck coil.

• Journal of the Korean Society of Radiology
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• v.82 no.6
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• pp.1619-1627
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• 2021

Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.

• Investigative Magnetic Resonance Imaging
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• v.12 no.2
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• pp.188-196
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• 2008

Purpose : To describe the clinical, MR imaging, and pathologic findings of pediatric meningiomas. Materials and Methods : The authors retrospectively reviewed the medical records and MR images of 16 pediatric patients with pathologically proven meningioma. Mean patient age at diagnosis was 14 years (range, 3-18). MR images were reviewed for details of lesion sizes, locations, signal intensity (SI), marginal characteristics, internal architectures, enhancements, and dural and parenchymal changes. The findings of other imaging modalities and of pathological examinations were also analyzed. Results : Mean tumor size was 5.24 cm (range, 1.3-18.1 cm) and locations were supratentorial in 12 and infratentorial in 4. SI of masses were variable, that is, high in 9, iso in 4, and low in 3 on T2 weighted images (T2WI), and low (n=11), iso (n=4), or high (n=1) on T1WI images. All lesions were visualized as well-demarcated enhancing masses. Five of the tumors were heterogeneous with cystic or necrotic components. Dural attachment was observed in 11 patients and adjacent brain edema in 10. Tumors exhibited hyperdense (n=6) or isodense (n=4) on non-enhanced CT scans, and 3 of the 7 angiograms demonstrated blood supply from the internal carotid artery. Pathologic examinations revealed the following subtypes; transitional cell (n=4), meningotheliomatous (n=4), chordoid (n=2), fibrous (n=2), clear cell (n=1), hyalinized (n=1), rhabdoid papillary (n=1), and atypical (n=1). Conclusion : Pediatric meningiomas occur usually in teenagers, have diverse pathological types, and may produce atypical imaging findings, such as, a heterogeneous internal content or findings suggestive of intraaxial tumors.

• Journal of the Korean Society of Radiology
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• v.15 no.7
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• pp.999-1005
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• 2021

The object of this research is CS, which increases resolution while shortening inspection time, is applied to MRA to compare the quality of images for SENSE and CS techniques and to evaluate SNR and CNR to find out the optimal techniques and to provide them as clinical basic data based on this information. Data were analyzed on 32 patients who performed TOF MRA tests at a university hospital in Chung cheong-do (15 males, 17 females), ICA stenosis:10, M1 Aneurysm:10, and average age 53 ± 4.15). In the inspection, the inspection equipment was Ingenia CX 3.0T, Archieva 3.0T, and 32 channel head coil and 3D gradient echo as a method for equipment data. SNR and CNR of each image were measured by quantitative analysis, and the quality of the image was evaluated by dividing the observer's observation into 5 grades for qualitative evaluation. Imaging evaluation is described as being significant when the p-value is 0.05 or less when the paired T-test and Wilcoxon test are performed. Quantitative analysis of SNR and CNR in TOF MRA images Compared to the SENSE method, the CS method is a method measurement method (p <0.05). As an observer's evaluation, the sharpness of blood vessels: CS (4.45 ± 0.41), overall image quality: CS (4.77 ± 0.18), background suppression of images: CS (4.57 ± 0.18) all resulted in high CS technique (p = 0.000). In conclusion, the Compressed SENSE TOF MRA technique shows superior results when comparing and evaluating the SENSE and Compressed SENSE techniques in increased flow rate magnetic resonance angiography. The results are thought to be the clinical basis material in the 3D TOF MRA examination for brain disease.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.941-947
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• 2000

Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.698-703
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• 2001

Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

• Journal of the Korean Society of Radiology
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• v.84 no.6
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• pp.1361-1366
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• 2023

The persistent primitive olfactory artery (PPOA) is a rare variant of the anterior cerebral artery, first reported in 1979. It reportedly has a high correlation with the development of aneurysms, owing to the hemodynamic stress induced by the structural characteristics of the hairpin turn. Herein, we present a rare case of PPOA type 4 with a fusiform aneurysm at the hairpin turn segment in a 46-year-old female with occasional headaches. Time-of-flight MR angiography and transfemoral cerebral angiography revealed an unusual branch arising from the left A1 segment, running anteromedially along the ipsilateral olfactory tract, and turning the hairpin posterior to the olfactory bulb. This branch continued into the left accessory middle cerebral artery, and a fusiform aneurysm was observed at the hairpin segment. No further treatment was performed, and follow-up imaging was recommended. Nevertheless, it is essential to recognize and diagnose these rare variations.