• 대한치과의사협회지
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• 제56권12호
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• pp.695-706
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• 2018

Objectives: The purpose of this study was to investigate the ratio of 4 root canals and the incidence of Radix Entomolaris in mandibular first molars and find out anatomical difference according to number of roots by analysis of cone-beam CT images in a Korean population. Materials and Methods: Total 142 images containing mandibular first molars were selected from CBCT images taken from 2013 to 2017 at Gangneung-Wonju National University Dental Hospital. After reconstructing the image with reference to the Cemento-enamel junction, the root canals were detected at the bottom of the pulpal floor and the number of roots and root canals were analyzed. Various lengths and MLO-DLO-DBO angle were measured between each canal orifices and the external contour line of the tooth, and the distolingual canal wall thickness was measured. Student t-test was used for statistical significance. Results: Among the total 142 teeth, 4 canals were 42.2% and Radix Entomolaris was 25.3%. As the results of measuring various lengths and the angle, the distolingual canal orifice in Group 2(with Radix Entomolaris) tends to deviate to the lingual side than the mesiolingual canal orifice and to the mesial side than the distobuccal canal orifice. Besides, thickness of the distolingual canal wall in Group 2(with Radix Entomolaris) was significantly thinner than that of Group 1 at every level except pulpal floor level. Conclusion: It is necessary to consider the difference according to the presence of Radix Entomolaris in endodontic treatment.

• 한국임상수의학회지
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• 제38권3호
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• pp.135-142
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• 2021

The aim of this study was to evaluate the contrast effect if a saline flush following low-volume contrast medium bolus improves vascular and parenchymal enhancement using a saphenous vein in abdominal CT for small animals. Six clinically healthy beagle dogs underwent abdominal contrast-enhanced CT. They were divided into nine groups (each group, n = 6), according to the volume of contrast medium 1, 2, and 3 mL/kg, and volume of the saline solution 0, 5, and 10 mL. Dynamic CT scanning was performed at the hepatic hilum level. The maximum contrast enhancement, time to maximum enhancement, and time to equilibrium phase were calculated from the time attenuation curves. Mean attenuation values for all groups were measured in the aorta, portal vein, and liver. After contrast enhancement, grading of image quality regarding surrounding artifacts and evaluation of the hepatic hilum structures was performed. For comparison of the effect of the contrast material and saline solution doses, differences in mean attenuation values between the contrast medium 2 mL/kg without saline flush group and the remaining groups, and between contrast medium 3 mL/kg without saline flush group and the remaining groups, were analyzed for statistical significance. There were no significant differences between with and without saline flushing at the same contrast medium dose groups. There were no significant differences in peak values between the 3 mL/kg dose of contrast medium alone and the 2 mL/kg dose of contrast medium with saline solution flush. However, there was a significant difference in peak values between the 3 mL/kg dose of the contrast medium without the saline flush group and the 2 mL/kg dose of the contrast medium alone group. Grades of the artifacts were not significantly different in the saline flush regardless of the dose of the contrast medium. Using 2 mL/kg of contrast medium with saline solution flush resulted in similar liver parenchyma attenuation, compared with using 3 mL/kg of contrast medium without saline solution flush. In CT evaluation of hepatic parenchymal diseases, using 2 mL/kg of contrast medium with saline solution flush may yield decreased risk of contrast nephropathy and cost-saving.

• 한국방사선학회논문지
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• 제16권5호
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• pp.537-543
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• 2022

본 연구의 목적은 이중에너지 CT를 이용한 유효원자번호 정보를 통한 췌장 검출 가능성 연구이다. 10개의 다양한 인체 등가 물질의 유효원자번호를 Stoichiometric calibration을 통해 추정하였다. Stoichiometric calibration을 위해 저에너지와 고에너지에 해당하는 10개 인체 등가 물질에 대한 HU값을 이용하였다. 이를 바탕으로 반복 알고리즘을 통해 인체 등가 물질에 대한 유효원자번호 영상을 추출하였다. 연구결과에 따르면, 유효원자번호에 따른 감약의 비는 R²값이 0.9999로 추정되었고, Pancreas, water, Liver, Blood, Spongiosa, Cortical bone의 유효원자번호는 이론값과 비교하여 전체적으로 1% 이내의 정확도를 보였다. 췌장암 검사는 조영제를 사용하므로 잠재적인 조영제 부작용 가능성이 있다. 이를 해결하기 위해 조영 증강 없는 이중에너지를 이용한 유효원자번호 추출을 통해 정확하고 안전한 검사에 기여할 수 있을 것으로 사료된다. 본 연구를 바탕으로 향후 연구에서는 임상 영상을 바탕으로 췌장암의 HU값을 이용하여 췌장암 검출에 대한 연구를 수행할 것이다.

• 한국방사선학회논문지
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• 제17권1호
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• pp.123-129
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• 2023

본 연구에서는 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사와 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사의 영상의 질과 선량의 차이를 분석하고자 하였다. 간세포암종의 중재적 시술인 경도관동맥화학색전술 대상으로 정맥과 동맥 경유 역동적 간 조영 컴퓨터단층촬영 검사를 한 케이스를 후향적 블라인드 방법으로 신호대잡음비와 대조도대잡음비를 분석하였다. 또한 영상저장 및 전송체계에 저장된 Dose Length Product (DLP)값을 이용하여 유효선량을 구하여 두 검사의 선량 차이를 분석하였다. 신호대잡음비는 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 간과 지라에서 높은 결과를 보였지만 대조도대잡음비는 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 높았다. 하지만 DLP와 유효선량 비교에서는 두 검사 간 차이가 발생하지 않았다. 결론적으로 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사에 비해 선량차이가 발생하지 않으면서도 대조도대잡음비가 우수한 검사임을 확인하였다. 추가로 간세포암종의 중재적 시술에서 가장 중요한 부분이 섭식동맥의 구분이 명료한가에 대한 구분이 필요하기 때문에 간동맥의 삼차원 혈관조영 컴퓨터단층촬영 검사에 대한 분석이 필요하다고 사료된다.

• 한국방사선학회논문지
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• 제17권6호
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• pp.835-841
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• 2023

팬텀모델에서 이중에너지 전산화단츨촬영(DECT)를 이용한 요로결석의 성분분석을 통해 임상적 유용성에 대해 알아보고자 한다. 17명의 환자로부터 요로결석을 추출하여, 작은 플라스틱 병(Plastic Bottle) 안에 각각의 요로결석을 삽입한 후, 인체와 비슷한 돈육을 이용하여 실험팬텀을 제작하였다. 640-Slice MSCT(Auquilion ONE, Toshiba Medical Center, Japan)의 이중에너지 방식에서 Volume scan 방식을 사용하여 촬영하였고, 얻어진 두 가지의 영상을 Dual-energy software("DE stone Analysis" software version 4.3, Toshiba)에서 요산석과 비요산석의 성분분석하고 HU값을 각각 측정하였다. 요로결석의 성분은 전체 17개의 요로결석 중에서 요산석은 6개(35.29%)였고, 비요산석은 11개(64.71%)로 나타났다. 요산석의 경우 135kV는 348.87±166.37, 100kV는 345.33±151.18, 80kV는 337.94±172.77로 나타났고, 비요산석의 경우 135kV는 551.93±297.09, 100kV는 747.04±351.31, 80kV는 958.19±424.72로 나타났다. 80kV에서는 요산석과 비요산석의 HU값의 차이가 통계적으로 유의한 차이를 보였고(P<0.05), 비요산석의 경우에 80kV와 135kV의 HU값은 통계적의 유의한 차이를 보였다(P<0.05). 시술 후 적출된 요로결석을 이용한 팬텀실험연구에서는 DECT를 이용하여 에너지에 따라 서로 다르게 변화하는 HU값의 차이로 요산석과 비요산석을 구분할 수 있었다. 향후, 이중에너지에 대한 연구와 재구성방법의 연구가 진행된다면, 요로결석의 치료에 DECT가 유용할 것으로 기대된다.

• Korean Journal of Radiology
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• 제22권4호
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• pp.624-633
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• 2021

Objective: To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. Materials and Methods: A phantom, simulating the L2-4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. Results: The skeletal muscle area (threshold, -29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30-150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0-44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. Conclusion: Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.

• Korean Journal of Radiology
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• 제22권6호
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• pp.994-1004
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• 2021

Objective: To extract pulmonary and cardiovascular metrics from chest CTs of patients with coronavirus disease 2019 (COVID-19) using a fully automated deep learning-based approach and assess their potential to predict patient management. Materials and Methods: All initial chest CTs of patients who tested positive for severe acute respiratory syndrome coronavirus 2 at our emergency department between March 25 and April 25, 2020, were identified (n = 120). Three patient management groups were defined: group 1 (outpatient), group 2 (general ward), and group 3 (intensive care unit [ICU]). Multiple pulmonary and cardiovascular metrics were extracted from the chest CT images using deep learning. Additionally, six laboratory findings indicating inflammation and cellular damage were considered. Differences in CT metrics, laboratory findings, and demographics between the patient management groups were assessed. The potential of these parameters to predict patients' needs for intensive care (yes/no) was analyzed using logistic regression and receiver operating characteristic curves. Internal and external validity were assessed using 109 independent chest CT scans. Results: While demographic parameters alone (sex and age) were not sufficient to predict ICU management status, both CT metrics alone (including both pulmonary and cardiovascular metrics; area under the curve [AUC] = 0.88; 95% confidence interval [CI] = 0.79-0.97) and laboratory findings alone (C-reactive protein, lactate dehydrogenase, white blood cell count, and albumin; AUC = 0.86; 95% CI = 0.77-0.94) were good classifiers. Excellent performance was achieved by a combination of demographic parameters, CT metrics, and laboratory findings (AUC = 0.91; 95% CI = 0.85-0.98). Application of a model that combined both pulmonary CT metrics and demographic parameters on a dataset from another hospital indicated its external validity (AUC = 0.77; 95% CI = 0.66-0.88). Conclusion: Chest CT of patients with COVID-19 contains valuable information that can be accessed using automated image analysis. These metrics are useful for the prediction of patient management.

• Korean Journal of Radiology
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• 제22권4호
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• pp.652-662
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• 2021

Objective: To investigate the association between CT imaging features and survival outcomes in patients with primary invasive mucinous adenocarcinoma (IMA). Materials and Methods: Preoperative CT image findings were consecutively evaluated in 317 patients with resected IMA from January 2011 to December 2015. The association between CT features and long-term survival were assessed by univariate analysis. The independent prognostic factors were identified by the multivariate Cox regression analyses. The survival comparison of IMA patients was investigated using the Kaplan-Meier method and propensity scores. Furthermore, the prognostic impact of CT features was assessed based on different imaging subtypes, and the results were adjusted using the Bonferroni method. Results: The median follow-up time was 52.8 months; the 5-year disease-free survival (DFS) and overall survival rates of resected IMAs were 68.5% and 77.6%, respectively. The univariate analyses of all IMA patients demonstrated that 15 CT imaging features, in addition to the clinicopathologic characteristics, significantly correlated with the recurrence or death of IMA patients. The multivariable analysis revealed that five of them, including imaging subtype (p = 0.002), spiculation (p < 0.001), tumor density (p = 0.008), air bronchogram (p < 0.001), emphysema (p < 0.001), and location (p = 0.029) were independent prognostic factors. The subgroup analysis demonstrated that pneumonic-type IMA had a significantly worse prognosis than solitary-type IMA. Moreover, for solitary-type IMAs, the most independent CT imaging biomarkers were air bronchogram and emphysema with an adjusted p value less than 0.05; for pneumonic-type IMA, the tumors with mixed consolidation and ground-glass opacity were associated with a longer DFS (adjusted p = 0.012). Conclusion: CT imaging features characteristic of IMA may provide prognostic information and individual risk assessment in addition to the recognized clinical predictors.

• Korean Journal of Radiology
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• 제21권11호
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• pp.1256-1264
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• 2020

Objective: Lung segmentation using volumetric quantitative computed tomography (CT) analysis may help predict outcomes of patients with coronavirus disease (COVID-19). The aim of this study was to investigate the relationship between CT volumetric quantitative analysis and prognosis in patients with COVID-19. Materials and Methods: CT images from patients diagnosed with COVID-19 from February 18 to April 15, 2020 were retrospectively analyzed. CT with a negative finding, failure of quantitative analysis, or poor image quality was excluded. CT volumetric quantitative analysis was performed by automated volumetric methods. Patients were stratified into two risk groups according to CURB-65: mild (score of 0-1) and severe (2-5) pneumonia. Outcomes were evaluated according to the critical event-free survival (CEFS). The critical events were defined as mechanical ventilator care, ICU admission, or death. Multivariable Cox proportional hazards analyses were used to evaluate the relationship between the variables and prognosis. Results: Eighty-two patients (mean age, 63.1 ± 14.5 years; 42 females) were included. In the total cohort, male sex (hazard ratio [HR], 9.264; 95% confidence interval [CI], 2.021-42.457; p = 0.004), C-reactive protein (CRP) (HR, 1.080 per mg/dL; 95% CI, 1.010-1.156; p = 0.025), and COVID-affected lung proportion (CALP) (HR, 1.067 per percentage; 95% CI, 1.033-1.101; p < 0.001) were significantly associated with CEFS. CRP (HR, 1.164 per mg/dL; 95% CI, 1.006-1.347; p = 0.041) was independently associated with CEFS in the mild pneumonia group (n = 54). Normally aerated lung proportion (NALP) (HR, 0.872 per percentage; 95% CI, 0.794-0.957; p = 0.004) and NALP volume (NALPV) (HR, 1.002 per mL; 95% CI, 1.000-1.004; p = 0.019) were associated with a lower risk of critical events in the severe pneumonia group (n = 28). Conclusion: CRP in the mild pneumonia group; NALP and NALPV in the severe pneumonia group; and sex, CRP, and CALP in the total cohort were independently associated with CEFS in patients with COVID-19.

• 대한영상의학회지
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• 제85권2호
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• pp.445-450
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• 2024

자궁 경부암의 위 전이는 매우 드물며, 소수의 증례만이 영문 문헌에서 보고되었다. 자궁경부 위형 점액샘암종은 드문 아형의 점액샘암종이다. 위형 점액샘암종은 진행성 암에서 발견되는 공격적인 암이지만, 위로의 전이는 보고된 바 없다. 저자들은 61세 여성의 자궁경부 위형 점액샘암종이 위 날문방에 전이된 증례를 보고하며 위 전이 및 자궁경부 점액샘암종의 영상의학적 소견을 서술하고자 한다. 위 전이는 조영증강이 잘되지 않는 점막 하 종괴로 보였다. 점액샘암종은 조영증강이 잘되지 않는 침윤성 종괴로 보였다. 확산강조영상에서는 경도의 고신호강도를 보였고 겉보기확산계수 지도에서는 낮은 값을 보였다. 이 사례는 매우 드물며 진단이 어렵지만, 자궁경부암의 유형이 사람유두종바이러스 비의존 위형 점액샘암종이며 동시에 위의 점막 하 병변이 발견된 경우, 우리 사례와 유사한 패턴의 전이 가능성을 고려할 수 있다.