• Investigative Magnetic Resonance Imaging
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• v.24 no.1
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• pp.38-45
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• 2020

Background: Differentiation of cerebellopontine angle (CPA) schwannoma from meningioma is often a difficult process to identify. Purpose: To identify imaging features for distinguishing CPA schwannoma from meningioma and to investigate the usefulness of susceptibility-weighted imaging (SWI) in differentiating them. Materials and Methods: Between March 2010 and January 2015, this study pathologically confirmed 11 meningiomas and 20 schwannomas involving CPA with preoperative SWI were retrospectively reviewed. Generally, the following MRI features were evaluated: 1) maximal diameter on axial image, 2) angle between tumor border and adjacent petrous bone, 3) presence of intratumoral dark signal intensity on SWI, 4) tumor consistency, 5) blood-fluid level, 6) involvement of internal auditory canal (IAC), 7) dural tail, and 8) involvement of adjacent intracranial space. On CT, 1) presence of dilatation of IAC, 2) intratumoral calcification, and 3) adjacent hyperostosis were evaluated. All features were compared using Chi-squared tests and Fisher's exact tests. The univariate and multivariate logistic regression analysis were performed to identify imaging features that differentiate both tumors. Results: The results noted that schwannomas more frequently demonstrated dark spots on SWI (P = 0.025), cystic consistency (P = 0.034), and globular angle (P = 0.008); schwannomas showed more dilatation of internal auditory meatus and lack of calcification (P = 0.008 and P = 0.02, respectively). However, it was shown that dural tail was more common in meningiomas (P < 0.007). In general, dark spots on SWI and dural tail remained significant in multivariate analysis (P = 0.037 and P = 0.012, respectively). In this case, the combination of two features showed a sensitivity and specificity of 80% and 100% respectively, with an area under the receiver operating characteristic curve of 0.9. Conclusion: In conclusion, dark spots on SWI were found to be helpful in differentiating CPA schwannoma from meningioma. It is noted that combining dural tail with dark spots on SWI yielded strong diagnostic value in differentiating both tumors.

• Imaging Science in Dentistry
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• v.49 no.4
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• pp.273-279
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• 2019

Purpose: This study was performed to investigate the effects of energy level, reconstruction kernel, and tube rotation time on Hounsfield unit (HU) values of hydroxyapatite (HA) in virtual monochromatic images (VMIs) obtained with dual-energy computed tomography (DECT)(Siemens Healthineers, Erlangen, Germany). Materials and Methods: A bone density calibration phantom with 3 HA inserts of different densities(CTWATER^®; 0, 100, and 200 mg of HA/㎤) was scanned using a twin-beam DECT scanner at 120 kVp with tube rotation times of 0.5 and 1.0 seconds. The VMIs were reconstructed by changing the energy level (with options of 40 keV, 70 keV, and 140 keV). In order to investigate the impact of the reconstruction kernel, virtual monochromatic images were reconstructed after changing the kernel from body regular 40 (Br40) to head regular 40 (Hr40) in the reconstruction phase. The mean HU value was measured by placing a circular region of interests (ROIs) in the middle of each insert obtained from the VMIs. The HU values were compared with regard to energy level, reconstruction kernel, and tube rotation time. Results: Hydroxyapatite density was strongly correlated with HU values(correlation coefficient=0.678, P<0.05). For the HA 100 and 200 inserts, HU decreased significantly at increased energy levels(correlation coefficient= -0.538, P<0.05) but increased by 70 HU when using Hr40 rather than Br40 (correlation coefficient=0.158, P<0.05). The tube rotation time did not significantly affect the HU(P>0.05). Conclusion: The HU values of hydroxyapatite were strongly correlated with hydroxyapatite density and energy level in VMIs obtained with DECT.

• The Journal of Korean Academy of Prosthodontics
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• v.49 no.3
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• pp.222-228
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• 2011

Purpose: The purposes of this study were to evaluate the stress distributions and the displacements of obturator for edentulous maxillectomy patients and to compare them with those of complete denture using three-dimensional finite element analysis. Materials and methods: Based on the CT image of edentulous patient, three-dimensional finite element model of edentulous maxillae was constructed. Three-dimensional finite element model of edentulous maxillae with palatal defect was also fabricated. On each model, complete denture and obturator prosthesis were created. Vertical static force of 200 N was applied on the left maxillary premolar and molar region. The von Mises stress values and the displacements of models were analyzed using three-dimensional finite element analysis. Results: Maximum von Mises stress values were recorded in the cortical bones of both models. The von Mises stress value in the complete denture model was 2.73 MPa and 2.69 MPa in the obturator model. High von Mises stress values were also observed on the tissue surface of prosthesis. The maximum value of the displacement in the obturator was higher than that of complete denture. Conclusion: The obturator showed a worse result in terms of stress distribution and displacement than complete denture. In the prosthodontic rehabilitation of edentulous maxillectomy patient accurate impression procedure based on patients'anatomy and application of prosthodontic principle should be considered.

• Progress in Medical Physics
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• v.28 no.4
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• pp.149-155
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• 2017

Radiotherapy patients should maintain their treatment position as patient setup is very important for accurate treatment. In this study, we evaluated patient setup error quantitatively according to Cone-Beam Computed Tomography (CBCT) Gamma Density Analysis using Mobius CBCT. The adjusted setup error to the $QUASAR^{TM}$ phantom was moved artificially in the superior and lateral direction, and then we acquired the CBCT image according to the phantom setup error. To analyze the treatment setup error quantitatively, we compared values suggested in the CBCT system with the Mobius CBCT. This allowed us to evaluate the setup error using CBCT Gamma Density Analysis by comparing the planning CT with the CBCT. In addition, we acquired the 3D-gamma density passing rate according to the gamma density criteria and phantom setup error. When the movement was adjusted to only the phantom body or 3 cm diameter target inserted in the phantom, the CBCT system had a difference of approximately 1 mm, while Mobius CBCT had a difference of under 0.5 mm compared to the real setup error. When the phantom body and target moved 20 mm in the Mobius CBCT, there are 17.9 mm and 13.5 mm differences in the lateral and superior directions, respectively. The CBCT gamma density passing rate was reduced according to the increase in setup error, and the gamma density criteria of 0.1 g/cc/3 mm has 10% lower passing rate than the other density criteria. Mobius CBCT had a 2 mm setup error compared with the actual setup error. However, the difference was greater than 10 mm when the phantom body moved 20 mm with the target. Therefore, we should pay close attention when the patient's anatomy changes.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.649-656
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• 2020

Objective : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.5
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• pp.462-469
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• 2000

Positron Emission Tomography(PET) is a new diagnostic method that can create functional images of the distribution of positron emitting radionuclides, which when administered intravenously in the body, makes possible anatomical and functional analysis by quantity of biochemical and physiological process. After genetic and biochemical changes in initial stage, malignant tumor undergoes functional changes before undergoing anatomical changes. So, early diagnosis of malignant tumors by functional analysis with PET can be achieved, replacing traditional anatomical analysis, such as computed tomography(CT) and magnetic resonance image(MRI), etc. Similarly, PET can identify malignant tumor without confusion with scar and fibrosis in follow up check. In the Korea Cancer Center Hospital(KCCH) from October 1997 to September 1999, clinical study was performed in 79 cases that underwent 89 times PET evaluation with [18F]-Fluorodeoxyglucose for diagnosis of oral and maxillofacial tumors, and the data was analysed by Bayesian $2{\times}2$ Classification Table. The results were as follows : Evaluation for initial diagnosis with FDG-PET (P<0.005) 1. Agreement rate or accuracy rate is 88.9%. 2. Sensitivity is 95.2%, and specificity 66.7%. 3. Positive predictive rate is 90.9%, and negative predictive rate 80.0%. 4. In consideration of tumor stage, diagnostic rate in less than stage II was 90% and in greater than stage III 100%. 5. In consideration of tumor size, diagnostic rate in less than T2 was 92.3% and in greater than T3 100%. After primary treatment, evaluation for follow up check with FDG-PET (P < 0.001) 1. Agreement rate or accuracy rate is 85.4%. 2. Sensitivity is 87.5%, and specificity 82.4%. 3. Positive predictive rate is 87.5%, and negative predictive rate 82.4%. 4. In 24 recurred cases, 6 had distant metastasis, and 5 of them were diagnosed with FDG-PET, resulting in diagnostic rate of FDG-PET of 83.3%. From the above results, Positron Emission Tomography with [18F]- Fluorodeoxyglucose appears to be more sensitive and accurate for detecting the presence of oral and maxillofacial tumors, and has various clinical applications such as early diagnosis of tumor in initial and follow up check and detection of distant metastasis.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.40-44
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• 2008

Purpose: The purpose of this study was to report the real geometry of Resident's ridge doing in anterior cruciate ligament reconstruction Materials and Methods: From Jan 2007 to Aug 2007, 48 cases which had normal distal femoral condyle analyzed with Multidetector-Row Computed Tomography. Resident's ridge was defined as change of height above 1 mm in lateral wall of intercondylar notch. Anterior-posterior length of intercondylar notch, length and height of Resident's ridge, distance of Resident's ridge from posterior cortex were estimated with 3-D reconstruction using $Lucion^{(R)}$ program. Results: Cases were $59{\pm}16$ years olds and male was 16 cases, female was 32 cases. 9 cases had no Resident's ridge, anterior-posterior length of intercondylar notch was $25.4{\pm}3.5$ mm, average of length and height of the Resident's ridge was $8.2{\pm}2.6,\;3.5{\pm}1.5$ mm. Distance of the Resident's ridge from posterior cortex was $7.6{\pm}2.6$ mm. Conclusion: Resident's ridge was used as landmark in anterior cruciate ligament reconstruction, which presented in many cases and which had distinct length and height.

• Journal of Dental Rehabilitation and Applied Science
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• v.22 no.2
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• pp.173-180
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• 2006

Objectives The aim of this study is to compare the quality of root canal preparation completed using MFile-$System^{(R)}$ instrument ( Komet, Gebr.Brsaseler, Germany) and conventional stainless steel file in the canals of Maxillary molar teeth that had a canal curvature between $25^{\circ}$ or more Materials & Methods Buccal canals of 24 first and second maxillary molar teeth, extracted for periodontal and prosthetic reasons were used. Tissue fragments and calcified debris were removed from teeth by scaling and the teeth were stored in 10% formalin solution for 24 hour. Then, teeth were stored in saline until used. To be included the roots had to have completed formed apices and angle of curvature ranging between $25^{\circ}$ or more according to the criteria described by Schneider(1971). Palatal and Second mesiobuccal canals were not included. Teeth were embedded into transparent acrylic. The teeth were randomly divided into two experimental groups. All teeth were scanned by Dental CT (PSR9000N, Asahi, Japan) to determine the root canal shape before instrumentation. Image slices were prepared from the apical end point to the pulp chamber. The first two sections were 2 mm from the apical end of root and 2 mm below the orifice. Further section was recorded, dividing the distance between the sections of apical and coronal levels into two equal lengths. 12 teeth were instrumented using stainless steel fileand another 12 teeth were instrumented using MFile-$System^{(R)}$. Following the completion of the instrumentation, the teeth were again scanned and compared with the cross sectional images taken prior to canal preparation. Amount of transportation and centering ability was assessed. Student's t-test was used for statistical analysis. Result Less transportation occurred with MFile-$System^{(R)}$ rotary instrumentation than stainless steel instrument. MFile-$System^{(R)}$ had better centering ability than stainless steel instrument. Conclusion MFile-$System^{(R)}$ rotary instrumentation transported canals less and had good centering ability.

• Progress in Medical Physics
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• v.20 no.3
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• pp.125-131
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• 2009

In this study, the paclitaxel eluting stent (PES) was prepared by coating a biliary stent with paclitaxel using various biopolymer such as poly (vinyl acetate) (PVAc), poly (lactic-co-glycolic acid) (PLGA), Silicone rubber for restenosis prevention in gastrointestinal disease by a dip-coating method. Drug contents of PES were increased as surface area of stent, concentration and molecular weight of coating polymer increase. In $^1H-NMR$ specta, we know that drug did not change by confirming specific peaks of paclitaxel in PES. As shown in SEM image, PES prepared using various biopolymer is coated clearly and regularly except Silicone rubber coating polymer. In in vitro cell cytotoxicity test, bare stent showed low cytotoxic effect against CT-26 colon carcinoma cell line on 3 day. However, PES coated with PLGA 502H showed the highest cytotoxicity because PLGA 502H is biodegradable polymer and has less molecular weight than other coating polymer. These results suggest that PES coated various biopolymer can be prevented restenosis in gastrointestinal disease.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.225-231
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• 2017

Objective : Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. Methods : From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. Results : Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. Conclusion : Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.