• Korean Journal of Radiology
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• 제20권5호
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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.

• 대한방사선기술학회지:방사선기술과학
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• 제43권6호
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• pp.475-480
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• 2020

The purpose of this study was to reconstruct diffusion tensor tractography (DTT) using stem of garlic and asparagus for in vitro phantom of diffusion tensor imaging (DTI), and to compare and evaluate the fractional anisotropy (FA) value and the apparent diffusion coefficient (ADC) value to determine whether it can be used as materials for in vitro phantoms. Among various plant fibers such as stem of garlic, palmae, cotton, asparagus, etc., stem of garlic and asparagus, which are considered to be the most suitable for making phantoms, and whose shape is considered to be the most suitable for making phantoms, were selected and tests were conducted. Holes were made in a plastic bucket at an angle of 0°, 30°, 60°, 90°, and 120°, then tubes were inserted. In the tube, asparagus and stem of garlic were inserted as far in as possible, and the inserted tube was inserted into the center of the heat bathed gelatin to harden. We were able to reproduce DTT images in asparagus and stem of garlic. Fiber tissues of asparagus and stem of garlic did not show complete connectivity, but the reconstructed images of DTT showed good connectivity. The FA values of asparagus in the tubes were 0.198 at 0° (straight), 0.207 at 30°, 0.187 at 60°, 0.231 at 90°, and 0.204 at 120°. In addition, the FA values of stem of garlic in the tubes were 0.235 at 0°, 0.236 at 30°, 0.216 at 60°, 0.218 at 90°, and 0.257 at 120°. The ADC values of asparagus in the tubes were 1.545 at 0°, 1.677 at 30°, 1.629 at 60°, 1.535 at 90°, and 1.725 at 120°. In addition, the ADC values of stem of garlic in the tubes were 1.252 at 0°, 1.396 at 30°, 1.698 at 60°, 1.756 at 90°, and 1.466 at 120°. For the best expressed DTT reconstruction image, it showed the longest connectivity in the straight line as we hypothesized. In addition, when comparing the FA values and ADC values of fiber tissues of stem of garlic and asparagus, FA value was generally higher in stem of garlic and ADC value was slightly higher in asparagus.

• Korean Journal of Radiology
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• 제22권5호
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• pp.751-758
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• 2021

Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis. Materials and Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error. Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively. Conclusion: Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.154-161
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• 2017

Purpose: To evaluate the diagnostic performance of diffusion-weighted steady-state free precession (DW-SSFP) in comparison to diffusion-weighted echo-planar imaging (DW-EPI) for differentiating the neoplastic and benign osteoporotic vertebral compression fractures. Materials and Methods: The subjects were 40 patients with recent vertebral compression fractures but no history of vertebroplasty, spine operation, or chemotherapy. They had received 3-Tesla (T) spine magnetic resonance imaging (MRI), including both DW-SSFP and DW-EPI sequences. The 40 patients included 20 with neoplastic vertebral fracture and 20 with benign osteoporotic vertebral fracture. In each fracture lesion, we obtained the signal intensity normalized by the signal intensity of normal bone marrow (SI norm) on DW-SSFP and the apparent diffusion coefficient (ADC) on DW-EPI. The correlation between the SI norm and the ADC in each lesion was analyzed using linear regression. The optimal cut-off values for the diagnosis of neoplastic fracture were determined in each sequence using Youden's J statistics and receiver operating characteristic curve analyses. Results: In the neoplastic fracture, the median SI norm on DW-SSFP was higher and the median ADC on DW-EPI was lower than the benign osteoporotic fracture (5.24 vs. 1.30, P = 0.032, and 0.86 vs. 1.48, P = 0.041, respectively). Inverse linear correlations were evident between SI norm and ADC in both neoplastic and benign osteoporotic fractures (r = -0.45 and -0.61, respectively). The optimal cut-off values for diagnosis of neoplastic fracture were SI norm of 3.0 in DW-SSFP with the sensitivity and specificity of 90.4% (95% confidence interval [CI]: 81.0-99.0) and 95.3% (95% CI: 90.0-100.0), respectively, and ADC of 1.3 in DW-EPI with the sensitivity and specificity of 90.5% (95% CI: 80.0-100.0) and 70.4% (95% CI: 60.0-80.0), respectively. Conclusion: In 3-T MRI, DW-SSFP has comparable sensitivity and specificity to DW-EPI in differentiating the neoplastic vertebral fracture from the benign osteoporotic vertebral fracture.

• 한국의학물리학회지:의학물리
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• 제21권2호
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• pp.153-164
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• 2010

혈관분포도(vascularity) 및 세포조밀도(cellularity)와 같은 종양의 생물학적 특성을 고려한 임상표적체적을 결정하기 위하여, 국부혈류용적영상(regional cerebral blood volume map, rCBV map)과 겉보기확산계수영상(apparent diffusion coefficient map, ADC map)의 종양 체적을 해부학적 영상 위에 맵핑 할 수 있는 소프트웨어를 개발하였다. 개발한 프로그램은 해부학적 영상 및 기능 영상 간 mutual information, affine transform, non-rigid registration을 이용한 영상 정합 기능을 제공한다. 영상 정합 후 기준 영상과 정합된 영상에서 획득한 각 segmented bone의 겹치는 체적 비율 및 contour 간 평균 거리를 이용하여 정합도 평가도 가능하다. 잔여 종양이 있는 악성신경아교종 환자의 영상을 이용하여 소프트웨어의 기능을 평가하였을 때, bone segmentation과 contour 간 평균 거리 차이를 이용한 정합도는 각각 약 74%와 2.3 mm였으며, 수동정합을 이용하여 2~5% 정도의 정합도를 향상 시킬 수 있었다. 종양의 생물학적 특성을 치료 계획에 반영할 수 있도록, color map을 이용하여 rCBV map을 분석하였으며, ADC map에서 설정한 관심 영역의 평균 확산 계수와 표준 편차 등을 계산하여 종양의 예후 인자 및 악성도를 평가하였다. 두 기능 영상이 공통적으로 나타내는 종양 체적에서 얻은 생물학적 인자를 평면 위에 맵핑하여 종양의 특성을 쉽게 파악할 수 있는 multi-functional parametric map을 구성하였다. 또한 각기능 인자에 대응되는 악성 종양의 임계값을 적용하여 주변 종양 세포에 비하여 혈관 분포도는 높으면서 확산 계수는 낮아 악성 종양 세포일 확률이 높은 영역을 구분할 수 있었다. 각 기능 영상 위에서 설정한 생물학적 종양 체적 및 악성도가 높은 국소 체적은 해부학적 영상 위에 표시하여 dicom 파일로 출력할 수 있었다. 개발한 소프트웨어는 기능적 다중영상을 이용하여 생물학적 종양 체적을 해부학적 영상 위에 맵핑하는데 적용할 수 있으며, 해부학적 영상에서 파악하기 어려운 종양의 특성 변화들을 치료 계획에 활용할 수 있다. 나아가 개발한 소프트웨어를 이용하여, 한 종류의 영상을 참고하여 종양 체적을 결정했을 때 발생할 수 있는 오류를 줄이고, 치료 전이나 치료 과정에서 나타나는 종양의 조직학적, 생리학적 특성을 치료 계획에 접목하는데 활용할 수 있다.

• Investigative Magnetic Resonance Imaging
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• 제6권2호
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• pp.166-172
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• 2002

목적: 척수경색의 진단에서 현성확산계수 값의 측정을 포함한 확산강조자기공명영상의 유용성을 평가하고자하였다. 대상 및 방법: 척수 경색으로 진단받은 6명의 환자를 대상으로 후향적으로 분석하였다. 경색증상 발현 후 평균 5.4일이 지난 후에 1.5 T 초전도체 자기공명영상 기기를 이용하여 자기공명영상을 얻었다. 확산강조자기공명영상은 고식적인 b값($1000s/\textrm{mm}^2$)으로 하여 multi-shot echo planar imaging 기법을 이용하여 영상을 획득하였으며 개인용 컴퓨터로 옮겨져 현성확산계수 지도를 얻어 정상부위와 병변부위의 현성확산계수 값을 측정하였다. 자기공명영상에서 병변의 위치와 T1 과 T2 강조영상, 그리고 확산강조자기공명영상에서 나타나는 각각의 신호강도를 알아 보았고, 병변부위와 정상부위에서 측정한 현성확산계수 값을 비교하였다. 결과: T1강조영상에서 6예 중 4예에서 등신호강도를, 2예에서 저신호 강도를 보였고, T2강조 영상에서 6예 모두 고신호강도를 보였다. 또한 확산강조자기공명영상에서 6예 모두 고신호강도를 보였다. 현성확산계수 지도는 6예 전예에서 성공적으로 얻을 수 있었다. 현성확산계수 지도에서 6예 모두 정상과 뚜렷한 차이를 보이는 색조변화를 보였으며, 6예 모두 병변부위의 현성확산계수 값은 정상 부위의 현성확산계수의 값보다 더 낮았으며 통계적으로 유의하였다 (p＜0.05 ). 결론: 척수경색 환자에서 척수병변의 확산강조자기공명영상과 현성확산계수 값의 측정이 가능하였다. 따라서 확산강조자기공명영상은 척수경색의 조기진단과 국재화(localization)에 유용하리라 보여진다.

• Journal of Yeungnam Medical Science
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• 제36권3호
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• pp.231-240
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• 2019

Background: We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas. Methods: Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), $K^{trans}$ (vessel permeability), and $V_e$ (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences. Results: There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, $K^{trans}$, and $V_e$ values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were $0.71{\pm}0.05$, $0.80{\pm}0.05$, and $0.85{\pm}0.05$, respectively. Conclusion: Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

• 대한의생명과학회지
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• 제11권1호
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• pp.31-36
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• 2005

To evaluate the magnetic resonance imaging and electron microscopic findings of the hyperacute stage of cerebral fat embolism in cats and the time needed for the development of vasogenic edema. Magnetic resonance imaging was performed at 30 minutes (group 1, n=9) and at 30 minutes and 1, 2, 4, and 6 hours after embolization with triolein (group 2, n= 10). As a control for group 2, the same acquisition was obtained after embolization with polyvinyl alcohol particles (group 3, n=5). Electron microscopic examination was done in all cats. In group 1, the lesions were iso- or slightly hyperintense on T2-weighted (T2W) and diffusion-weighted (DWIs) images, hypointense on the apparent diffusion coefficient (ADC) map image, and markedly enhanced on the gadolinium-enhanced T1-weighted images (Gd-T1WIs). In group 2 at 30 minutes, the lesions were similar to those in group 1. Thereafter, the lesions became more hyperintense on T2WIs and DWIs and more hypoinfense on the ADC map image. In group 3, the lesions showed mild hyperintensity on T2WIs at 6 hours but hypointensity on the ADC map image from 30 minutes, with a tendency toward a greater decrease over time. Electron microscopic findings revealed discontinuity of the capillary endothelial wall, perivascular and interstitial edema, and swelling of glial and neuronal cells in groups 1 and 2. The lesions were hyperintense on T2WIs and DWIs, hypointense on the ADC map image, and enhanced on Gd-T1WIs. On electron microscopy, the lesions showed cytotoxic and vasogenic edema with disruption of the blood-brain barrier.

• Korean Journal of Radiology
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• 제22권2호
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• pp.233-242
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• 2021

Objective: To evaluate the association of MRI features with the major genomic profiles and prognosis of World Health Organization grade III (G3) gliomas compared with those of glioblastomas (GBMs). Materials and Methods: We enrolled 76 G3 glioma and 155 GBM patients with pathologically confirmed disease who had pretreatment brain MRI and major genetic information of tumors. Qualitative and quantitative imaging features, including volumetrics and histogram parameters, such as normalized cerebral blood volume (nCBV), cerebral blood flow (nCBF), and apparent diffusion coefficient (nADC) were evaluated. The G3 gliomas were divided into three groups for the analysis: with this isocitrate dehydrogenase (IDH)-mutation, IDH mutation and a chromosome arm 1p/19q-codeleted (IDHmut1p/19qdel), IDH mutation, 1p/19q-nondeleted (IDHmut1p/19qnondel), and IDH wildtype (IDHwt). A prediction model for the genetic profiles of G3 gliomas was developed and validated on a separate cohort. Both the quantitative and qualitative imaging parameters and progression-free survival (PFS) of G3 gliomas were compared and survival analysis was performed. Moreover, the imaging parameters and PFS between IDHwt G3 gliomas and GBMs were compared. Results: IDHmut G3 gliomas showed a larger volume (p = 0.017), lower nCBF (p = 0.048), and higher nADC (p = 0.007) than IDHwt. Between the IDHmut tumors, IDHmut1p/19qdel G3 gliomas had higher nCBV (p = 0.024) and lower nADC (p = 0.002) than IDHmut1p/19qnondel G3 gliomas. Moreover, IDHmut1p/19qdel tumors had the best prognosis and IDHwt tumors had the worst prognosis among G3 gliomas (p < 0.001). PFS was significantly associated with the 95th percentile values of nCBV and nCBF in G3 gliomas. There was no significant difference in neither PFS nor imaging features between IDHwt G3 gliomas and IDHwt GBMs. Conclusion: We found significant differences in MRI features, including volumetrics, CBV, and ADC, in G3 gliomas, according to IDH mutation and 1p/19q codeletion status, which can be utilized for the prediction of genomic profiles and the prognosis of G3 glioma patients. The MRI signatures and prognosis of IDHwt G3 gliomas tend to follow those of IDHwt GBMs.

• Korean Journal of Radiology
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• 제23권2호
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• pp.218-225
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• 2022

Objective: This study aimed to explore the feasibility of functional evaluation of the lateral pterygoid muscle (LPM) using diffusion tensor imaging (DTI) in patients with temporomandibular joint disorders (TMDs). Materials and Methods: A total of 119 patients with TMD (23 male and 96 female; mean age ± standard deviation, 41 ± 15 years; 58 bilateral and 61 unilateral involvements for a total of 177 joints) and 20 healthy volunteers (9 male and 11 female; 40 ± 13 years; 40 joints) were included in this prospective study. Based on DTI of the jaw in the resting state, the diffusion parameters, apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 of the superior and inferior heads of the LPM (SHLPM and IHLPM) were measured. Patients with TMD with normal disc position (ND), anterior disc displacement with reduction (ADWR), and anterior disc displacement without reduction (ADWOR) were compared. Results: Patients with TMD overall, and ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 in both the SHLPM and IHLPM than those in volunteers (p < 0.05 for all), whereas the ND subgroup only had significantly higher ADC and λ1 (p < 0.001). Meanwhile, significant differences in FA in the SHLPM and IHLPM were found between volunteers and ADWOR (p = 0.014 and p = 0.037, respectively). Among the three TMD subgroups, except for λ3 and FA in the ADWR subgroup, ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 and lower FA than those in the ND group (p < 0.050). There was no significant difference in diffusion variables between ADWR and ADWOR. In ADWOR, the osteoarthritis group had significantly higher λ3 and lower FA values in the IHLPM than those in the non-osteoarthritis group. Conclusion: DTI successfully detected functional changes in the LPM in patients with TMD. The unsynchronized diffusivity changes in the LPM in different subgroups of TMD signified the possibility of using diffusion parameters as indicators to identify the severity of LPM hyperfunction at various stages of TMD.