• Proceedings of the KSMRM Conference
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• 2003.10a
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• pp.49-53
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• 2003

확산텐서영상(Diffusion Tensor Imaging)의 개념은 1980년대 중반 확산강조영상(Diffusion Weighted Imaging)의 개념이 도입되면서 거의 동시에 도입되었지만 MR 장비의 기계적 한계등으로 인해 최근에야 임상적으로 사용되기 시작했다. 확산텐서영상(DTI)과 확산강조영상(DWI)의 방법론적인 차이점은 단순히 확산강조영상의 경우 세 개의 다른방향 (X-, Y-, Z-축)으로 확산측정용 경사자장을 가하는 반면 확산텐서영상의 경우 이보다 많은 방향 (최소한 6 방향)으로 확산측정용 경사자장을 가한다는 점이다. 이러한 차이로부터 금방 알 수 있는 점은 확산강조영상은 확산텐서영상의 일부라는 점이다. 즉, 확산텐서영상의 경우 더 많은 방향으로 확산측정용 경사자장을 가했으므로 더 많은 정보를 획득할 수 있고 이중 세 개의 방향 (주로 X,Y,Z)에 대한 정보만을 이용하게 되면 확산강조영상이다. 이러한 이유로 확산텐서영상을 획득하면 확산강조영상에서 얻게 되는 방향별 확산강조영상, 등방성(isotropic) 확산강조영상, ADC (Apparent Diffusion Coefficient) map등도 기본적으로 얻게 되므로 추가로 확산강조영상을 획득할 필요가 없다. 본 강의에서는 이러한 확산(텐서)영상의 물리적 원리를 복잡한 수학적 설명보다는 개념 위주로 설명해 보고자 한다.

• Investigative Magnetic Resonance Imaging
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• v.20 no.4
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• pp.250-253
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• 2016

Acute Japanese encephalitis (JE) is an endemic viral infectious disease in various parts of Far East and Southeast Asian countries including Korea. Bilateral thalami are the most common involving sites in JE. Other areas including the basal ganglia, substantia nigra, red nucleus, pons, cerebral cortex and cerebellum may be also involved. We report an extremely unusual brain diffusion-weighted MR imaging (DWI) findings in a 53-year-old man with serologically proven JE involving unilateral deep gray matter and temporal lobe, which shows multifocal high signal intensities in left thalamus, left substantia nigra, left caudate nucleus and left medial temporal cortex on T2-weighted image and DWI with iso-intensity on apparent diffusion coefficient (ADC) map.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6155-6160
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• 2014

Background: This study was conducted to investigate whether apparent diffusion coefficient (ADC) measurements by dividing the liver into left and right hepatic lobes may be utilized to improve the accuracy of differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 269 consecutive patients with 429 focal liver lesions were examined by 3-T magnetic resonance imaging that included diffusion-weighted imaging. For 58 patients with focal liver lesions of the same etiology in left and right hepatic lobes, ADCs of normal liver parenchyma and focal liver lesions were calculated and compared using the paired t-test. For all 269 patients, ADC cutoffs for focal liver lesions and diagnostic accuracy in the left hepatic lobe, right hepatic lobe and whole liver were evaluated by receiver operating characteristic curve analysis. Results: For the group of 58 patients, mean ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. For differentiating malignant lesions from benign lesions in all patients, the sensitivity and specificity were 92.6% and 92.0% in the left hepatic lobe, 94.4% and 94.4% in the right hepatic lobe, and 90.4% and 94.7% in the whole liver, respectively. The area under the curve of the right hepatic lobe, but not the left hepatic lobe, was higher than that of the whole liver. Conclusions: ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. Optimal ADC cutoff for focal liver lesions in the right hepatic lobe, but not in the left hepatic lobe, had higher diagnostic accuracy compared with that in the whole liver.

• Korean Journal of Radiology
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• v.22 no.2
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• pp.253-262
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• 2021

Objective: To determine whether the values of hepatic apparent diffusion coefficient (ADC) can differentiate biliary atresia (BA) from non-BA or be correlated with the grade of hepatic fibrosis in infants with cholestasis. Materials and Methods: This retrospective cohort study included infants who received liver MRI examinations to evaluate cholestasis from July 2009 to October 2017. Liver ADC, ADC ratio of liver/spleen, aspartate aminotransferase to platelet ratio index (APRI), and spleen size were compared between the BA and non-BA groups. The diagnostic performances of all parameters for significant fibrosis (F3-4) were obtained by receiver-operating characteristics (ROCs) curve analysis. Results: Altogether, 227 infants (98 males and 129 females, mean age = 57.2 ± 36.3 days) including 125 BA patients were analyzed. The absolute ADC difference between two reviewers was 0.10 mm²/s for both liver and spleen. Liver ADC value was specific (80.4%) and ADC ratio was sensitive (88.0%) for the diagnosis of BA with comparable performance. There were 33 patients with F0, 15 with F1, 71 with F2, 35 with F3, and 11 with F4. All four parameters of APRI (τ = 0.296), spleen size (τ = 0.312), liver ADC (τ = -0.206), and ADC ratio (τ = -0.288) showed significant correlation with fibrosis grade (all, p < 0.001). The cutoff values for significant fibrosis (F3-4) were 0.783 for APRI (area under the ROC curve [AUC], 0.721), 5.9 cm for spleen size (AUC, 0.719), 1.044 x 10^-3 mm²/s for liver ADC (AUC, 0.673), and 1.22 for ADC ratio (AUC, 0.651). Conclusion: Liver ADC values and ADC ratio of liver/spleen showed limited additional diagnostic performance for differentiating BA from non-BA and predicting significant hepatic fibrosis in infants with cholestasis.

• Journal of the Korean Society of Radiology
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• v.12 no.6
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• pp.755-762
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• 2018

The purpose of this study was to compare the FA(faractional anisotropy) and ADC(apparent diffusion coefficient) values, which were derived from diffusion tensor imaging in breast cancer patients. The diffusion gradient used in this study was derived from quantitative diffusion indices using 20 directions(b-value, 0 and $1,000s/mm^2$). Quantitative analysis was analyzed using Pearson's correction and qualitative analysis using for correction coefficients. As a result, $FA_{min}$, $FA_{mean}$ and $FA_{max}$ were $0.098{\pm}0.065$, $0.302{\pm}0.142$ and $0.634{\pm}0.236$, respectively(p > 0.05). The $ADC_{min}$, $ADC_{mean}$ and $ADC_{max}$ were $0.741{\pm}0.403$, $1.095{\pm}0.394$ and $1.530{\pm}0.447$, respectively(p > 0.05). The $FA_{min}$, $FA_{mean}$, and $FA_{max}$ mean values were $0.132{\pm}0.050$, $0.418{\pm}0.094$, and $0.770{\pm}0.164$ for Category 6 and Kinetic Curve Pattern III, respectively. $ADC_{min}$, $ADC_{mean}$, and $ADC_{max}$ were $0.753{\pm}0.189$, $1.120{\pm}0.236$, and $1.615{\pm}0.372$, respectively. Quantitative analysis showed negative correlation between $ADC_{mean}-FA_{mean}$ and $ADC_{max}-FA_{max}$(p = 0.001, 0.003). The qalitative analysis showed ADC 0.628(p = 0.001), FA 0.620(p = 0.001) in the internal evaluations, ADC 0.677(p = 0.001), FA 0.695(p = 0.001) in external evaluations. In conclusion, based on the morphological examination, time to signal intensity graph is the form of wash-out(pattern III) in the dynamic contrast enhance examination, As a result, the $ADC_{mean}$ $1.120{\pm}0.236$ and $FA_{mean}$ values were $0.032{\pm}0.142$ with a negative correlation (Y=1.44-1.12X). Therefore, If we understand the shape of time to signal intensity graph and the relationship between ADC and FA, It will be a criterion for distinguishing malignant diseases in breast cancer.

• Proceedings of the KSMRM Conference
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• 2003.10a
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• pp.99-99
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• 2003

To exhibit our clinical experience of diffusion-weighted (DW) MR imaging for various brain pathologies and to determine its role in characterizing brain pathologies in children. DW images in 177 children (M：F＝96：81, mean age, 4.7 years) with various brain pathologies were retrospectively collected over past 3 years. DW images (b value： 1000 s/mm) were reviewed along with corresponding apparent diffusion coefficient (ADC) maps. Brain pathologies included cystic or solid brain tumor (n = 55), cerebral infarct (n = 32), cerebritis with or without brain abscess (n = 21), metabolic or toxic brain disorder (n = 19), demyelinating disease (n = 16), hypoxic-ischemic encephalopathy (n = 16), intracerebral hemorrhage including traumatic brain lesion (n = 15), and posterior reversible leukoencephalopathy (n = 3). We reviewed whether DW images and ADCmaps contribute to further characterization of brain pathologies by defining a chronological age of lesions, the presence of cytotoxic edema in lesions, and the nature of cystic lesions.

• Journal of Korean Neurosurgical Society
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• v.64 no.3
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• pp.418-426
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• 2021

Objective : A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not well-understood. This study evaluates the effectiveness of DWI in the diagnosis of CVT. Methods : Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue. Results : Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference-0.33×10-3 ㎟/s [95% CI, -0.44 to -0.23]; p<0.00001). Conclusion : DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.

• Korean Journal of Radiology
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• v.21 no.1
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• pp.77-87
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• 2020

Objective: To assess the feasibility of simultaneous multislice-accelerated diffusion-weighted imaging (SMS-DWI) of the rectum in comparison with conventional DWI (C-DWI) in rectal cancer patients. Materials and Methods: This study included 65 patients with initially-diagnosed rectal cancer. All patients underwent C-DWI and SMS-DWI with acceleration factors of 2 and 3 (SMS2-DWI and SMS3-DWI, respectively) using a 3T scanner. Acquisition times of the three DWI sequences were measured. Image quality in the three DWI sequences was reviewed by two independent radiologists using a 4-point Likert scale and subsequently compared using the Friedman test. Apparent diffusion coefficient (ADC) values for rectal cancer and the normal rectal wall were compared among the three sequences using repeated measures analysis of variance. Results: Acquisition times using C-DWI, SMS2-DWI, and SMS3-DWI were 173 seconds, 107 seconds, (38.2% shorter than C-DWI), and 77 seconds (55.5% shorter than C-DWI), respectively. For all image quality parameters other than distortion (margin sharpness, artifact, lesion conspicuity, and overall image quality), C-DWI and SMS2-DWI yielded better results than did SMS3-DWI (Ps < 0.001), with no significant differences observed between C-DWI and SMS2-DWI (Ps ≥ 0.054). ADC values of rectal cancer (p = 0.943) and normal rectal wall (p = 0.360) were not significantly different among C-DWI, SMS2-DWI, and SMS3-DWI. Conclusion: SMS-DWI using an acceleration factor of 2 is feasible for rectal MRI resulting in substantial reductions in acquisition time while maintaining diagnostic image quality and similar ADC values to those of C-DWI.

• Korean Journal of Radiology
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• v.2 no.4
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• pp.183-191
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• 2001

Objective: To document the signal characteristics of intracerebral hemorrhage (ICH) at evolving stages on diffusion-weighted images (DWI) by comparison with conventional MR images. Materials and Methods: In our retrospective study, 38 patients with ICH underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR). In 33 and 10 patients, respectively, conventional and echo-planar T2^* gradient-echo images were also obtained. According to the time interval between symptom onset and initial MRI, five stages were categorized: hyperacute (n=6); acute (n=7); early subacute (n=7); late subacute (n=10); and chronic (n=8). We investigated the signal intensity and apparent diffusion coefficient (ADC) of ICH and compared the signal intensities of hematomas at DWI and on conventional MR images. Results: DWI showed that hematomas were hyperintense at the hyperacute and late subacute stages, and hypointense at the acute, early subacute and chronic stages. Invariably, focal hypointensity was observed within a hyperacute hematoma. At the hyperacute, acute and early subacute stages, hyperintense rims that corresponded with edema surrounding the hematoma were present. The mean ADC ratio was 0.73 at the hyperacute stage, 0.72 at the acute stage, 0.70 at the early subacute stage, 0.72 at the late subacute stage, and 2.56 at the chronic stage. Conclusion: DWI showed that the signal intensity of an ICH may be related to both its ADC value and the magnetic susceptibility effect. In patients with acute stroke, an understanding of the characteristic features of ICH seen at DWI can be helpful in both the characterization of intracranial hemorrhagic lesions and the differentiation of hemorrhage from ischemia.

• Korean Journal of Radiology
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• v.20 no.5
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• pp.801-811
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• 2019

Objective: To determine whether diffusion kurtosis imaging (DKI) is effective in monitoring tumor response to neoadjuvant chemotherapy in patients with osteosarcoma. Materials and Methods: Twenty-nine osteosarcoma patients (20 men and 9 women; mean age, 17.6 ± 7.8 years) who had undergone magnetic resonance imaging (MRI) and DKI before and after neoadjuvant chemotherapy were included. Tumor volume, apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and change ratio (ΔX) between pre-and post-treatment were calculated. Based on histologic response, the patients were divided into those with good response (≥ 90% necrosis, n = 12) and those with poor response (< 90% necrosis, n = 17). Several MRI parameters between the groups were compared using Student's t test. The correlation between image indexes and tumor necrosis was determined using Pearson's correlation, and diagnostic performance was compared using receiver operating characteristic curves. Results: In good responders, MD_post, ADC_post, and MK_post values were significantly higher than in poor responders (p < 0.001, p < 0.001, and p = 0.042, respectively). The ΔMD and ΔADC were also significantly higher in good responders than in poor responders (p < 0.001 and p = 0.01, respectively). However, no significant difference was observed in ΔMK (p = 0.092). MD_post and ΔMD showed high correlations with tumor necrosis rate (r = 0.669 and r = 0.622, respectively), and MD_post had higher diagnostic performance than ADC_post (p = 0.037) and MK_post (p = 0.011). Similarly, ΔMD also showed higher diagnostic performance than ΔADC (p = 0.033) and ΔMK (p = 0.037). Conclusion: MD is a promising biomarker for monitoring tumor response to preoperative chemotherapy in patients with osteosarcoma.