• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제4권1호
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• pp.68-78
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• 1993

Tourette씨병과 만성틱장애는 7세 전후한 연령에서 가장 흔히 시작되는 소아 또는 청소년기의 행동장애로서 서로 밀접한 관련성을 가지고 있으며, 또한 유전적인 경향이 아주 강한 질환들로 알려져 있다. 원인으로서도 여러가지 가설이 있으나 뇌의 기능 또는 기질적인 장애로 인하여 발병될 가능성도 클 것으로 추정되고 있다. 이에 본 연구는 이 질환들의 생물학적인 원인들 중 일부를 살펴보기 위하여 단일광자방출 전산화단층촬영술을 시행하고 다음과 같은 결과를 얻었다. 1) 31.0%(13/42)에서 대뇌피질의 혈류감소 소견을 보였으며, 전두엽이 가장 흔한 혈류 이상 소견을 보인 부위였다.2) 4.8%(2/42)애서 대뇌기저핵의 혈류에 감소를 나타내었다. 3) 4.8%(2/42)에서 시상부의 혈류감소가 관찰되었다. 4) 16.7%(7/42)에서 소뇌의 혈류감소가 관찰되었다. 5) 주의력결핍과잉운동장애가 동반된 군과 동반되지 않은 군간에 혈류장애의 빈도에 있어서의 차이는 관찰되지 않았다. 6) Tourette씨병과 만성틱장애에 있어서, 혈류장애가 동반된 빈도에 있어서의 차이는 관찰되지 않았다. 이상의 걸과로 미루어 Tourette씨병과 만성틱장애의 생물학적인 원인중의 하나로 뇌혈류장애와 관계가 있을 가능성이 있으며, 뇌혈류의 정도를 정량화시키거나, 또는 자기공명영상과 같은 방법을 병행하여 연구를 시행함으로써, 본 연구의 타당성을 높여줄 수 있으리라 기대된다.

• Journal of Chest Surgery
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• 제57권4호
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• pp.360-368
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• 2024

Background: The left pulmonary artery (LPA) may be kinked and stenotic, especially in tetralogy of Fallot, because of ductal tissue and anterior deviation of the conal septum. If LPA stenosis is not effectively treated during total correction, surgical angioplasty is occasionally performed. However, whether pulmonary artery (PA) angioplasty in adolescents or adults improves perfusion in the ipsilateral lung remains unclear. Methods: This retrospective review enrolled patients who underwent PA angioplasty for LPA stenosis between 2004 and 2019. Among patients who underwent a lung perfusion scan (LPS) or cardiac magnetic resonance imaging (cMRI) pre- and post-pulmonary angioplasty, those aged >13 years with <40% left lung perfusion (p-left) in the pre-angioplasty study were included. Preoperative and postoperative computed tomography, LPS, and cMRI data were collected. The perfusion ratio was analyzed according to the LPA's anatomical characteristics. Results: Seventeen adolescents and 16 adults (≥18 years old) were finally included (median age, 17 years). The most common primary diagnosis was tetralogy of Fallot (87.9%). In all patients, LPA angioplasty was performed concomitantly with right ventricular outflow tract reconstruction. No patients died. Preoperative p-left was not significantly different between adolescents and adults; however, adolescents had significantly higher postoperative p-left than adults. P-left significantly increased in adolescents, but not in adults. Seven patients had significant stenosis (z-score <-2.0) confined only to the proximal LPA and demonstrated significantly increased p-left. Conclusion: PA angioplasty significantly increased ipsilateral lung perfusion in adolescents. If focal stenosis is confined to the proximal LPA, PA angioplasty may improve ipsilateral lung perfusion, regardless of age.

• Korean Journal of Radiology
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• 제21권9호
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• pp.1095-1103
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• 2020

Objective: The present study aimed to investigate whether quantitative dual-energy computed tomography (DECT) parameters offer an incremental risk stratification benefit over the CT ventricular diameter ratio in patients with acute pulmonary embolism (PE) by using propensity score analysis. Materials and Methods: This study was conducted on 480 patients with acute PE who underwent CT pulmonary angiography (CTPA) or DECT pulmonary angiography (DE CT-PA). This propensity-matched study population included 240 patients with acute PE each in the CTPA and DECT groups. Altogether, 260 (54.1%) patients were men, and the mean age was 64.9 years (64.9 ± 13.5 years). The primary endpoint was all-cause death within 30 days. The Cox proportional hazards regression model was used to identify associations between CT parameters and outcomes and to identify potential predictors. Concordance (C) statistics were used to compare the prognoses between the two groups. Results: In both CTPA and DECT groups, right to left ventricle diameter ratio ≥ 1 was associated with an increased risk of all-cause death within 30 days (hazard ratio: 3.707, p < 0.001 and 5.573, p < 0.001, respectively). However, C-statistics showed no statistically significant difference between the CTPA and DECT groups for predicting death within 30 days (C-statistics: 0.759 vs. 0.819, p = 0.117). Conclusion: Quantitative measurement of lung perfusion defect volume by DECT had no added benefit over CT ventricular diameter ratio for predicting all-cause death within 30 days.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.280-288
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• 2013

Objective : Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. Methods : Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. Results : The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. Conclusion : PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권1호
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• pp.21-27
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• 2013

Objectives : Dysregulation of the central noradrenergic system may be involved in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). The aim of this study was to examine the differences in pre- and post-treatment cerebral perfusion according to the MspI polymorphisms of the alpha-2A-adrenergic receptor gene (ADRA2A) in children with ADHD. Methods : Thirty seven drug-naive ADHD children (8.9+1.8 years old, M=32, F=5) were genotyped. Baseline single-photon emission computed tomography (SPECT) and clinical assessments were performed for ADHD children. After treatment with methylphenidate for eight weeks, SPECT and clinical assessment were repeated. Results : No differences in baseline clinical assessments or cerebral perfusion were observed according to the MspI genotype. However, after treatment, ADHD children with the G/G genotype at the MspI polymorphism showed hyperperfusion in the right cerebellar declive (p=.001, uncorrected) and hypoperfusion in the left lentiform nucleus and left cingulate gyrus (p<.001 and p=.001, uncorrected), compared to children without the G/G genotype. Conclusion : Although the results of this study should be interpreted cautiously, they suggest a possible role of the MspI polymorphisms of the ADRA2A gene in methylphenidate-induced changes in cerebral perfusion.

• 대한방사선기술학회지:방사선기술과학
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• 제26권3호
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• pp.25-31
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• 2003

급성 허혈성 뇌경색 환자에서 Deconvolution 관류 전산화 단층촬영(computed tomography, CT)의 뇌혈류용적(cerebral blood volume, CBV), 뇌혈류(cerebral blood flow, CBF) 그리고 평균 조영제 통과 시간(mean transit time, MTT) 지도를 확산 강조(Diffusion weighted) MRI과 비교하여 그 유용성을 알아보고자 하였다. 뇌관류 CT와 확산강조 자기공명영상(diffusion weighted MR imaging, DWMRI)을 시행한 급성뇌경색 환자를 대상으로 Deconvolution 기법으로 획득한 CBV, CBF, MTT 지도에서 병변의 면적과 DWMRI의 병변의 면적을 비교 측정하여 일치도를 알아보았다. 또한, 병변 부위와 정상측 대칭부위의 MTT시간을 측정하여 차이를 알아보았다. 본 연구의 모든 예에서 CBV, CBF, 그리고 MTT 세 지도 모두 관류 결손을 인지할 수 있었고, 관류 결손이 인지되는 부위에서 MTT 시간의 현저한 지연이 있었다. 뿐만 아니라, MTT 지도의 결손부위 면적은 DWMRI 보다 크게 나타나 허혈성 패넘브라를 추측할 수 있었다. 결론적으로 Deconvolution 관류 CT의 지도를 이용하면 뇌경색의 조기진단뿐만 아니라 허혈 중심부, 그리고 허혈성 페넘브라를 예측할 수 있어 DWMRI에 비해 관류결손 부위의 혈류 역학적 상태의 평가나 효과적인 치료계획을 세우는데 보다 유용할 것으로 생각된다.

• 한국방사선학회논문지
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• 제18권3호
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• pp.213-222
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• 2024

본 연구는 폐 방사선 치료를 위한 컴퓨터 단층촬영의 관전압, 관전류 조건에 따라 딥 러닝과 아틀라스기반 자동분할 방법에 따른 생성된 볼륨과 Dice 유사도 계수와 95% 하우스도르프 거리를 분석하였다. 첫 번째 결과로 관전압 관전 류의 변화에 생성된 볼륨의 결과에서는 아틀라스기반인 smart segmentation 방법이 가장 적은 볼륨 변화를 보여주었으며, 딥 러닝을 사용한 Aview RT ACS와 OncoStudio에서는 100 mAs보다 낮은 관전류에서는 볼륨이 작아지는 걸 확인했다. 두 번째 결과인 Dice 유사도 계수에서는 Aview RT ACS가 OncoStuido 보다 2% 높은 결과를 보여주고 있으며, 95% 하우스도르프거리 결과에서도 Aview RT ACS가 OncoStudio 보다 평균 0.2~0.5% 높게 분석되었다. 하지만 관전류와 관전압에 따라 각각의 결과의 표준편차에서는 오히려 OncoStudio가 낮으므로 볼륨의 변화에서도 일관성 있을 거라 사료된다. 따라서 폐 방사선 치료를 위한 CT 촬영조건에서 낮은 관전압과 낮은 관전류에서 딥 러닝 기반 자동분할 프로그램을 사용할 때는 주의가 필요하며, 일정 관전압, 관전류 이상에서 기존에 사용하고 있는 아틀라스기반 자동분할 프로그램과 유사한 결과를 도출할 수 있었다.

• Korean Journal of Radiology
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• 제21권1호
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• pp.58-67
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• 2020

Objective: Third-generation dual-source computed tomography (3rd-DSCT) allows dynamic myocardial CT perfusion imaging (dynamic CTP) with a 10.5-cm z-axis coverage. Although the increased radiation exposure associated with the 50% wider scan range compared to second-generation DSCT (2nd-DSCT) may be suppressed by using a tube voltage of 70 kV, it remains unclear whether image quality and the ability to quantify myocardial blood flow (MBF) can be maintained under these conditions. This study aimed to compare the image quality, estimated MBF, and radiation dose of dynamic CTP between 2ndDSCT and 3rd-DSCT and to evaluate whether a 10.5-cm coverage is suitable for dynamic CTP. Materials and Methods: We retrospectively analyzed 107 patients who underwent dynamic CTP using 2nd-DSCT at 80 kV (n = 54) or 3rd-DSCT at 70 kV (n = 53). Image quality, estimated MBF, radiation dose, and coverage of left ventricular (LV) myocardium were compared. Results: No significant differences were observed between 3rd-DSCT and 2nd-DSCT in contrast-to-noise ratio (37.4 ± 11.4 vs. 35.5 ± 11.2, p = 0.396). Effective radiation dose was lower with 3rd-DSCT (3.97 ± 0.92 mSv with a conversion factor of 0.017 mSv/mGy∙cm) compared to 2nd-DSCT (5.49 ± 1.36 mSv, p < 0.001). Incomplete coverage was more frequent with 2nd-DSCT than with 3rd-DSCT (1.9% [1/53] vs. 56% [30/54], p < 0.001). In propensity score-matched cohorts, MBF was comparable between 3rd-DSCT and 2nd-DSCT in non-ischemic (146.2 ± 26.5 vs. 157.5 ± 34.9 mL/min/100 g, p = 0.137) as well as ischemic myocardium (92.7 ± 21.1 vs. 90.9 ± 29.7 mL/min/100 g, p = 0.876). Conclusion: The radiation increase inherent to the widened z-axis coverage in 3rd-DSCT can be balanced by using a tube voltage of 70 kV without compromising image quality or MBF quantification. In dynamic CTP, a z-axis coverage of 10.5 cm is sufficient to achieve complete coverage of the LV myocardium in most patients.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.429-433
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• 2013

Objectives: To explore the correlation between multi-slice spiral CT (MSCT) perfusion parameters and the expression of vascular endothelial growth factor (VEGF) as well as matrix metalloproteinase-2 (MMP-2) in breast cancer. Methods: Forty five breast cancer patients and 16 patients with benign breast tumor, both confirmed by pathology examination, were enrolled. All underwent MSCT perfusion imaging to obtain perfusion maps and data for parameters including blood flow (BF), blood volume (BV) and permeability surface (PS). Cancer patients did not receive treatment prior to surgery. The expression of VEGF and MMP-2 were examined with both immunohistochemistry and Western blotting. Results: The levels of VEGF and MMP-2 by immunohistochemistry were significantly higher in the breast cancer group (P < 0.01) than the benign tumor group. Relative OD values from Western blotting were also higher in cancer cases (P < 0.05). Similarly, the mean MSCT perfusion parameters (BF, BV, PS) were significantly higher in the breast cancer group (P < 0.01), BF and BV positively correlating with VEGF expression (r = 0.878 and 0.809 respectively, P < 0.01); PS and VEGF and MMP-2 expression were also positively correlated (r= 0.860, 0.786 respectively, P < 0.01). Conclusion: There is a correlation between breast cancer MSCT perfusion parameters and VEGF andMMP-2 expression, which might be useful for detection of breast lesions, qualitative diagnosis of breast cancer, and evaluation of breast cancer treatment.