• 대한디지털의료영상학회논문지
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• 제9권2호
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• pp.31-38
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• 2007

To evaluate the accuracy and extent in the localization of cerebral motor coutex activation using a gradient- echo echo planar imaging(GE-EPI) compared to spin-echo echo planar iimaging(SE-EPI) on 3T MR imaging. Functional MR imaging of cerebral motor cortex activation was examined in GE-EPI and SE-EPI in five healthy male volunteers. A right finger movement was accomplished with a paradigm of 6 task and rest, periods and the cross-correlation was used for a statistical mapping algorithm. We evaluated any sorts of differenced of the time seried and the signal intensity changes between the rest and task periods obtained with two technoques. The qualitative analysis was distributed with activation sites of large veins and small veins by using two techniques and was found that both the techniques were clinically uesful for delineating large veins and small veins in fMRL Signal intensity charge of the rest and activation periods provided simmilar activations in both methods(GE-EPI : 0.93$\pm$0.11, SE-EPI : 0.80$\pm$.015) but the signal intensity in GE-EPI(133.95$\pm$15.76) was larger than in SE-EPI(74.5$\pm$18.90). The average SNRs of EPI raw data were higher at SMA in SE-EPI(48.54$\pm$12.37) than GE-EPI(41.4$\pm$12.54) and at M1 in SE-EPI(43.24$\pm$11.77) than GE-EPI(38.27$\pm$6.53). The localization of activation voxels of the GE-EPI showed a larger vein but the SE-EPI generally showed small vein. Then the analysis results of the two techniques were used for a statistacal paired student t-test. SE-EPI was found clinically useful for localizing the cerebral moter cortex cativation on 3.0T, but showed a little different activation patterns comparad to GE-EPI. In conclusion, SE-EPI may be feasible and can detect true cortical activation from capillaries and GE-EPI can obtain the large veins in the motor cortex activation on 3T MR imaging.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.89-93
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• 2017

Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.

• Investigative Magnetic Resonance Imaging
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• 제18권4호
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• pp.332-340
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• 2014

목적: 급성 뇌경색 환자의 자화율강조영상에서 보이는 관류 손상 부위의 현저한 유출정맥 저신호 강도 (PHSV)의 임상적 유용성을 평가하고자 하였다. 대상과 방법: 확산강조영상과 자화율강조영상을 포함한 뇌 자기공명영상을 시행한 급성 뇌경색 환자에서 추적 단면영상검사가 있는 환자 18명을 대상으로 뇌경색 및 주변부에서 PHSV 유무와 위치를 정성적으로 확인하였다. 자화율강조영상에서 PHSV와 정상 뇌피질 정맥의 신호강도차이 비율을 측정하였고, 주변 PHSV 유무와 추적검사에서 뇌경색 크기 변화의 상관관계를 분석하였다. 결과: 18명의 환자 중 10명의 환자가 추적검사에서 뇌경색이 진행하였고, 8명은 변화가 없었다. 뇌경색이 진행한 10명의 환자 중 9명에서 뇌경색 주변 PHSV가 관찰되었고, 새로 생긴 경색 부위는 초기 자화율강조영상에서 보였던 주변 PHSV 부위와 잘 일치하였다. 경색의 크기가 변화 없는 환자군과 비교하여 경색이 진행한 환자군에서 뇌경색 주변 PHSV의 빈도가 통계적으로 유의하게 높았고 (p=0.0001), 신호강도차이 비율도 유의하게 높았다 (p=0.006). 결론: 자화율강조영상에서 보이는 주변 PHSV는 반음영부 (penumbra)의 지표가 될수 있으며 급성 뇌경색 예후 예측에 이용될 수 있다.

• Korean Journal of Radiology
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• 제22권3호
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• pp.395-404
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• 2021

Objective: To compare the utility of computed tomography perfusion (CTP) and three different 4-point scoring systems in computed tomography angiography (CTA) in confirming brain death (BD) in patients with and without skull defects. Materials and Methods: Ninety-two patients clinically diagnosed as BD using CTA and/or CTP for confirmation were retrospectively reviewed. For the final analysis, 86 patients were included in this study. Images were re-evaluated by three radiologists according to the 4-point scoring systems that consider the vessel opacification on 1) the venous phase for both M4 segments of the middle cerebral arteries (MCAs-M4) and internal cerebral veins (ICVs) (A60-V60), 2) the arterial phase for the MCA-M4 and venous phase for the ICVs (A20-V60), 3) the venous phase for the ICVs and superior petrosal veins (ICV-SPV). The CTP images were independently reviewed. The presence of an open skull defect and stasis filling was noted. Results: Sensitivities of the ICV-SPV, A20-V60, A60-V60 scoring systems, and CTP in the diagnosis of BD were 89.5%, 82.6%, 67.4%, and 93.3%, respectively. The sensitivity of A20-V60 scoring was higher than that of A60-V60 in BD patients (p < 0.001). CTP was found to be the most sensitive method (86.5%) in patients with open skull defect (p = 0.019). Interobserver agreement was excellent in the diagnosis of BD, in assessing A20-V60, A60-V60, ICV-SPV, CTP, and good in stasis filling (κ: 0.84, 0.83, 0.83, 0.83, and 0.67, respectively). Conclusion: The sensitivity of CTA confirming brain death differs between various proposed 4-point scoring systems. Although the ICV-SPV is the most sensitive, evaluation of the SPV is challenging. Adding CTP to the routine BD CTA protocol, especially in cases with open skull defect, could increase sensitivity as a useful adjunct.

• Clinical and Experimental Pediatrics
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• 제59권5호
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• pp.242-245
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• 2016

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%-5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.

• 대한한방내과학회지
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• 제25권3호
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• pp.633-639
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• 2004

A varicose vein of the lower limbs is dilated, tortuous and elongated vein. Western medical treatment involves conservative management, sclerotherapy, and surgery. Currently, internal medicinal treatment is inadequate. Recently a patient was diagnosed with varicose veins of the lower limbs based on clinical symptoms. In this case, Guibi-tang was administered and clinical symptoms improved. This report suggests that oriental medicinal treatment is efficacious in treating varicose veins of the lower limbs. We think that further oriental medical studies on various surgical diseases are needed.

• 대한영상의학회지
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• 제83권1호
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• pp.206-211
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• 2022

혈액투석 환자에서 중심정맥 협착은 비교적 흔한 합병증이다. 하지만 중심정맥 협착으로 인해 대뇌 정맥 고혈압과 이로 인한 신경학적 증상이 발생하는 것은 비교적 드물다. 중심정맥협착으로 인해 발생한 좌측 내경정맥으로부터의 역행성 혈류로 대뇌 정맥 고혈압이 발생한 63세 남성의 증례를 보고하고자 한다. 환자는 중심정맥 협착에 대한 치료를 받은 후 증상 및 치료 전 자기공명영상에서 역행성 혈류를 의미하는 time-of-flight 신호가 소실되었다.

• Anatomy and Cell Biology
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• 제56권1호
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• pp.32-38
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• 2023

The Galenic venous system plays a vital role in the drainage of blood from deeper parts of the brain. This venous system is contributed by many major veins. These veins are located closer to the pineal gland making the surgical approach in this region difficult. Any accidental injury or occlusion of the vein of Galen could lead to devasting results. Thus, studying the dimensions of the vein of Galen is more important. Hence, we aimed to evaluate the morphometry and trajectory to the vein of Galen. About 100 computed tomographic venography records were evaluated and the length, diameter of vein of Galen, angle between straight sinus and vein of Galen and distance from internal occipital protuberance and roof of fourth ventricle to vein of Galen were studied. The mean length and diameter of vein of Galen were 9.8±2.7 and 4.08±1.04 respectively. The mean angle between straight sinus and vein of Galen was 64.2°. The mean distance between external occipital protuberance and roof of fourth ventricle to vein of Galen were 52±6.9 and 33.3±4.5 respectively. No significant morphometric differences were observed between the age groups as well as between the sexs. The results obtained from this study may be helpful for the neurosurgeons in better understanding of the anatomy of the Galenic venous system and to adopt a safe surgical approach to improve the efficacy of the surgeries of the pineal gland and also in the region of vein of Galen.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.281-285
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• 2007

Objective : Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of DACA aneurysms, we reviewed our surgical strategy and its results postoperatively. Methods : A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January 1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe. Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation. Results : Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate disability, while 2 patients died. Conclusion : With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.423-427
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• 2006

Objective : Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem. Methods : Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal inter hemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling. Results : Seven patients [39%] developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling [p=0.031]. However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances. Conclusion : To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporal bone flap removal is recommended when it is indicated.