• Journal of the Korean Society of Radiology
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• v.5 no.4
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• pp.189-194
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• 2011

This study used magnetic resonance diffusion tensor imaging (DTI) to quantitatively analyze the neural fiber tractography according to the age of normal corpus callosum and to evaluate of usefulness. The research was intended for the applicants of 60 persons that was in a good state of health with not brain or other disease. The test parameters were TR: 6650 ms, TE: 66 ms, FA: $90^{\circ}$, NEX: 2, thickness: 2 mm, no gap, FOV: 220 mm, b-value: $800s/mm^2$, sense factor: 2, acquisition matrix size: $2{\times}2{\times}2mm^3$, and the test time was 3 minutes 46 seconds. The evaluation method was constructed the color-cored FA map include to the skull vertex from the skull base in scan range. We set up the five ROI of corpus callosum of genu, anterior-mid body, posterior-mid body, isthmus, and splenium, tracking, respectively, and to quantitatively measured the length of neural fiber. As a result, the length of neural fiber, for the corpus callosum of genu was 20's: $61.8{\pm}6.8$, 30's: $63.9{\pm}3.8$, 40's: $65.5{\pm}6.4$, 50's: $57.8{\pm}6.0$, 60's: $58.9{\pm}4.5$, more than 70's: $54.1{\pm}8.1mm$, for the anterior-mid body was 20's: $54.8{\pm}8.8$, 30's: $58.5{\pm}7.9$, 40's: $54.8{\pm}7.8$, 50's: $56.1{\pm}10.2$, 60's: $48.5{\pm}6.2$, more than 70's: $48.6{\pm}8.3mm$, for the posterior-mid body was 20's: $72.7{\pm}9.1$, 30's: $61.6{\pm}9.1$, 40's: $60.9{\pm}10.5$, 50's: $61.4{\pm}11.7$, 60's: $54.9{\pm}10.0$, more than 70's: $53.1{\pm}10.5mm$, for the isthmus was 20's: $71.5{\pm}17.4$, 30's: $74.1{\pm}14.9$, 40's: $73.6{\pm}14.2$, 50's: $66.3{\pm}12.9$, 60's: $56.5{\pm}11.2$, more than 70's: $56.8{\pm}11.3mm$, and for the splenium was 20's: $82.6{\pm}6.8$, 30's: $86.9{\pm}6.4$, 40's: $83.1{\pm}7.1$, 50's: $81.5{\pm}7.4$, 60's: $78.6{\pm}6.0$, more than 70's: $80.55{\pm}8.6mm$. The length of neural fiber for normal corpus callosum were statistically significant in the genu(P=0.001), posterior-mid body(P=0.009), and istumus(P=0.012) of corpus callosum. In order of age, the length of neural fiber increased from 30s to 40s, as one grows older tended to decrease. For this reason, the nerve cells of brain could be confirmed through the neural fiber tractography to progress actively in middle age.

• Clinical and Experimental Pediatrics
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• v.50 no.11
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• pp.1110-1115
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• 2007

Purpose : Idiopathic central diabetes insipidus (CDI) is defined in CDI patients without definite etiology. Some patients initially diagnosed as idiopathic CDI progressed to organic causes. We reviewed clinical, endocrinological, and radiological courses of 20 patients who was initially diagnosed as idiopathic CDI, to assess the predicting factors for progression to brain tumors. Methods : We reviewed the medical data and followed up their clinical courses in 20 CDI patients who had no definite organic etiology, such as malformation, tumor, at the time of diagnosis. Results : Our study included 15 males and 5 females. Mean age of CDI diagnosis was $7.8{\pm}3.6$ (2.1-14.7) years. Mean follow-up duration was $8.6{\pm}5.1$ (1.5-18) years. Six (30%) patients were diagnosed as brain tumor during follow-up. Ten (50%) of 20 patients had growth hormone deficiency. Multiple pituitary hormone deficiencies were found more frequently in brain tumor patients than idiopathic patients (60% vs 7%, P=0.037). Pituitary stalk thickening (PST) and loss of posterior pituitary signal were observed in 9 patients (47%), respectively. The newly development of PST was observed in patients diagnosed as brain tumor. Conclusion : About 30% of idiopathic CDI patients progress to organic disease such as germ cell tumor or histiocytosis. If there are multiple anterior pituitary hormone deficiency or newly development of PST, more close and careful follow-up is needed.

• 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.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.1
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• pp.135-143
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• 2009

Objectives : Low back pain(LBP) is a common disabling disease in clinical practice and loss of working hours due to this condition is huge. The aim of this study was to determine if there was an association between fat deposit of paraspinal muscles as observed on MRI scans in patients presenting with unilateral LBP. Methods : 24 patients who visiting our hospital with a clinical presentation of unilateral LBP were recruited to the study. Patients were between 20 and 30 years and had a history of unilateral LBP within 12 months. After MRI scaning, the images were saved in DICOM file format for Picture Archiving and Communication System(PACS). The percentage of fat infiltrated area was measured using a pseudocoloring technique. Data were analyzed comparing the fat deposits of the muscles on the symptomatic and asymptomatic sides. Paired t-test was used to find the difference between the measurements of fat tissue in individual patients. Results : The amount of fat in the symptomatic side was $7.6{\pm}4.51%$, asymptomatic side was $6.7{\pm}4.29%$. There were increases, statistically significant, in the fat changes of the paraspinal muscles at the L4-5 disc level(P <0.05). Also, men were likely than women to have more fat deposit in symptomatic side(men $8.5{\pm}5.1%$, women $6.5{\pm}3.6%$). Conclusions : The amount of fat in the symptomatic side shows significantly increased than asymptomatic side in the paraspinal muscles at the L4-5 disc level. It suggested that fat infiltration in the muscles associated with LBP. Further studies will be needed to confirm the relationship between the muscle fatty changes and LBP in the large sample size. In addition, the correlation of pain severity with fat infiltration needs to be addressed.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.53-60
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• 2006

Purpose: This study is to analyze the clinical and radiological results after arthroscopic reduction and internal fixation of intra-articular fractures of lateral tibial plateau. Materials and Methods: The subject of the study are the 13 cases of the patients visited orthopedics surgery during March year 2000 to August year 2004 because of intra-articular fractures of lateral tibial plateau and were treated with arthroscopic reduction and internal fixation. X-rays and CT or MRI were both carried out to identify the precise pattern of fracture and the degree of depression which showed out to be all type 2 by Schatzker fracture classification. And in 9 of the cases, autogenous and allogenous bone grafts were given as bone loss were severe. The average age was 48, age group between 31 and 66, and average follow up period of about 38 months ($13{\sim}65months$). Radiological ratings were given by comparing the X-rays of degree of joint congruency before and after the operation, functional ratings by analyzing IKDC score and Lysholm score. Combined injuries observed after arthroscopy were posterior cruciate ligament injury in 1 case, meniscus injury in 4 cases and medial collateral ligament in 2 cases. Results: During follow up, X-rays showed well-maintained reduction of articular surface in all cases and no complications such as joint depression, fracture reduction loss, angular deformity or malunion were found. Average Lysholm score at last follow up was 87 points ranging from 65 to 97, in 8 of the cases excellent, 3 good, 1 fair and 1 poor according to Lynsholm classification. Average IKDC score was 92 (from 82 to 99). Conclusion: Not only does arthroscopic reduction of lateral tibial plateau fracture bring exact reduction of articular surface, but also, is considered to be a good way of operation to diagnose and treat combined injuries of knee joint using arthroscopy.

• Journal of the Korean Society of Radiology
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• v.11 no.5
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• pp.343-351
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• 2017

T1, T2 relaxation time and relaxation rates were measured and analyzed according to the change of RF coil channel number of MAGiC sequence. T1, T2, R1 and R2 maps were obtained by using MAGiC sequence with phantom (1.0, 0.6, 0.2, 0 mM) on the RF coil with channel number of 1, 8, 16 and 32 respectively. T1, T2, R1, R2 values and relaxation rates were measured for each channel number and concentration, and Relaxivity was calculated according to each concentration. T1, T2, R1, and R2 values were measured in each coil. There was no significant difference between T1 and R1 values (p> 0.05). However, T2 and R2 values were significantly different (p <0.05). In the post-analysis results, T2 value was significantly different from that measured on 1, 8, 16, and 32 channel coils (p <0.05) and There was no difference between 8, 16, and 32 channel coils (p> 0.05). The R2 value was significantly different from that measured on the 8, 16, and 32 channel coils in the 1 channel coil, and the results on the 8 channel coils and the 16 channel coils showed a significant difference (P <0.05). In conclusion, T1 and R1 values were not significantly different according to the number of channels in the coil, but T2 and R2 values were significantly different. Therefore, when quantitative measurement of T2 and R2 values using the MAGiC sequence, the same number of coils should be used for reproducibility.

• Investigative Magnetic Resonance Imaging
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• v.22 no.1
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• pp.1-9
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• 2018

Purpose: This study was designed to optimize the flip angle (FA) and scan timing of the hepatobiliary phase (HBP) using the 3D T1-weighted, gradient-echo (GRE) imaging with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique on gadoxetic acid-enhanced 3T liver MR imaging. Materials and Methods: Sixty-two patients who underwent gadoxetic acid-enhanced 3T liver MR imaging were included in this study. Four 3D T1-weighted GRE imaging studies using the CAIPIRINHA technique and FAs of $9^{\circ}$ and $13^{\circ}$ were acquired during HBP at 15 and 20 min after intravenous injection of gadoxetic acid. Two abdominal radiologists, who were blinded to the FA and the timing of image acquisition, assessed the sharpness of liver edge, hepatic vessel clarity, lesion conspicuity, artifact severity, and overall image quality using a five-point scale. Quantitative analysis was performed by another radiologist to estimate the relative liver enhancement (RLE) and the signal-to-noise ratio (SNR). Statistical analyses were performed using the Wilcoxon signed rank test and one-way analysis of variance. Results: The scores of the HBP with an FA of $13^{\circ}$ during the same delayed time were significantly higher than those of the HBP with an FA of $9^{\circ}$ in all the assessment items (P < 0.01). In terms of the delay time, images at the same FA obtained with a 20-min-HBP showed better quality than those obtained with a 15-min-HBP. There was no significant difference in qualitative scores between the 20-min-HBP and the 15-min-HBP images in the non-liver cirrhosis (LC) group except for the hepatic vessel clarity score with $9^{\circ}$ FA. In the quantitative analysis, a statistically significant difference was found in the degree of RLE in the four HBP images (P = 0.012). However, in the subgroup analysis, no significant difference in RLE was found in the four HBP images in either the LC or the non-LC groups. The SNR did not differ significantly in the four HBP images. In the subgroup analysis, 20-min-HBP imaging with a $13^{\circ}$ FA showed the highest SNR value in the LC-group, whereas 15-min-HBP imaging with a $13^{\circ}$ FA showed the best value of SNR in the non-LC group. Conclusion: The use of a moderately high FA improves the image quality and lesion conspicuity on 3D, T1-weighted GRE imaging using the CAIPIRINHA technique on gadoxetic acid, 3T liver MR imaging. In patients with normal liver function, the 15-min-HBP with a $13^{\circ}$ FA represents a feasible option without a significant decrease in image quality.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.146-151
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• 2009

Purpose : To evaluate magnetic resonance (MR) imaging features of non-surgically treated tuberculous spondylitis and to evaluate the relationships between these features and clinical outcomes. Materials and Methods : Data from ten patients (male:female=6:4, mean age=45 years) with clinically proven tuberculous spondylitis who were treated nonsurgically over three months were analyzed retrospectively from 2000 to 2007. MRI was performed at least three times for each patient, at baseline, every three or six months, and at the end of treatment. All images were analyzed by two radiologists. Results : The mean follow-up period for the MR examination was 10.1 months (range, 4-17 months). Six patients had clinically complete resolution of tuberculous spondylitis with medication treatment only. Four patients were treated with surgical management alongside medication. All ten patients were divided into two groups by clinical outcome; six patients with complete treatment and four patients with incomplete treatment. In the complete treatment group, follow-up MR findings showed a loss of subligamentous spread of abscesses, decreased size of abscesses, no interval changes in vertebral body heights, and fatty changes in spinal lesions. MR findings in the incomplete treatment group showed bone marrow edema extension to adjacent vertebra, extension of the abscesses, and decreased height of the vertebral bodies. Conclusion : During the nonsurgical management of tuberculous spondylitis, MR imaging may play a role in predicting patient response to antituberculous drug treatment.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1040-1050
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• 1997

Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive $^{31}P$ magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31p MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase($6.91{\pm}0.1$ to $6.99{\pm}0.1$ and $6.76{\pm}0.2$ to $6.84{\pm}0.2$ respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabilitation.

• Tuberculosis and Respiratory Diseases
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• v.58 no.3
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• pp.295-298
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• 2005

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.