• 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.

• Journal of Korean Neurosurgical Society
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• 제65권5호
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• pp.633-639
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• 2022

Accurate diagnosis of trigeminal neuralgia (TN) is the starting point for optimal treatment. Gamma knife radiosurgery (GKRS) is currently regarded as one of the first-line treatment options for medically refractory TN. GKRS is a less invasive treatment with a low risk of complications than other surgical procedures that provides a favorable pain control Barrow Neurological Institute (BNI) I-IIIb rate of >75% at short-term follow-up. Drawbacks of GKRS include the latency period before pain relief and higher recurrence rate compared with microvascular decompression. Therefore, repeat treatment is necessary if the initial GKRS was effective but followed by recurrence. The concept of dose rate and the biologically effective dose of radiation has been actively studied in radiation oncology and is also applied in GKRS for TN to achieve high safety and efficacy by prescribing the optimal dose. Recent progress in functional imaging, such as diffusion tensor imaging, enables us to understand the pathophysiology of TN and predict the clinical outcome after GKRS. Here, we review TN, GKRS, and recent updates, especially in the concepts of radiation dose, diffusion tensor imaging studies, and repeat treatment in GKRS for TN.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2003년도 제8차 학술대회 초록집
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• pp.49-53
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• 2003

확산텐서영상(Diffusion Tensor Imaging)의 개념은 1980년대 중반 확산강조영상(Diffusion Weighted Imaging)의 개념이 도입되면서 거의 동시에 도입되었지만 MR 장비의 기계적 한계등으로 인해 최근에야 임상적으로 사용되기 시작했다. 확산텐서영상(DTI)과 확산강조영상(DWI)의 방법론적인 차이점은 단순히 확산강조영상의 경우 세 개의 다른방향 (X-, Y-, Z-축)으로 확산측정용 경사자장을 가하는 반면 확산텐서영상의 경우 이보다 많은 방향 (최소한 6 방향)으로 확산측정용 경사자장을 가한다는 점이다. 이러한 차이로부터 금방 알 수 있는 점은 확산강조영상은 확산텐서영상의 일부라는 점이다. 즉, 확산텐서영상의 경우 더 많은 방향으로 확산측정용 경사자장을 가했으므로 더 많은 정보를 획득할 수 있고 이중 세 개의 방향 (주로 X,Y,Z)에 대한 정보만을 이용하게 되면 확산강조영상이다. 이러한 이유로 확산텐서영상을 획득하면 확산강조영상에서 얻게 되는 방향별 확산강조영상, 등방성(isotropic) 확산강조영상, ADC (Apparent Diffusion Coefficient) map등도 기본적으로 얻게 되므로 추가로 확산강조영상을 획득할 필요가 없다. 본 강의에서는 이러한 확산(텐서)영상의 물리적 원리를 복잡한 수학적 설명보다는 개념 위주로 설명해 보고자 한다.

• Investigative Magnetic Resonance Imaging
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• 제20권4호
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• pp.250-253
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• 2016

Acute Japanese encephalitis (JE) is an endemic viral infectious disease in various parts of Far East and Southeast Asian countries including Korea. Bilateral thalami are the most common involving sites in JE. Other areas including the basal ganglia, substantia nigra, red nucleus, pons, cerebral cortex and cerebellum may be also involved. We report an extremely unusual brain diffusion-weighted MR imaging (DWI) findings in a 53-year-old man with serologically proven JE involving unilateral deep gray matter and temporal lobe, which shows multifocal high signal intensities in left thalamus, left substantia nigra, left caudate nucleus and left medial temporal cortex on T2-weighted image and DWI with iso-intensity on apparent diffusion coefficient (ADC) map.

• Clinical and Experimental Pediatrics
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• 제63권3호
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• pp.88-95
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• 2020

Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our understanding of the underlying etiology and improved our ability to noninvasively identify the seizure onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows better detection of the seizure onset zone, particularly when it is interpreted by experienced neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI, simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography (MEG) are noinvasive imaging modalities that can be used to localize the epileptogenic foci and assist in planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed tomography, and intracranial EEG monitoring. MEG and fMRI can localize and lateralize the area of the cortex that is essential for language, motor, and memory function and identify its relationship with planned surgical resection sites to reduce the risk of neurological impairments. These advanced structural and functional imaging modalities can be combined with postprocessing methods to better understand the epileptic network and obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.

• 한국의학물리학회지:의학물리
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• 제18권2호
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• pp.65-72
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• 2007

대부분의 임상용 자기공명영상 장치에서 확산텐서(difiusion tensor) 영상을 얻기 위하여 에코플렌(EPI) 스핀에코(spin-echo) 시퀀스를 사용한다. 하지만 이 영상법은 자화감수성에 매우 예민한 단점이 있다. 따라서 본 연구의 목적은 자화감수성에 의해 발생하는 영상의 변질을 최소화하면서 확산텐서를 한번에 얻을 수 있는 시퀀스를 개발하는데 있다. 모든 확산 텐서 성분을 한번에 얻기 위하여 다편(multi-slice) 8에코 스핀에코 시퀀스(MePGSE)가 개발되었다. 모든 180도 펄스는 기존에 사용된 방법과는 달리 선택된(slice selective) 경사자장을 이용하였다. 처음 7개의 에코 영상은 확산텐서 영상을 위하여 사용하였고, 마지막 에코 영상에서는 영상을 얻는 경사자장은 사용하지 않고 남아있는 자화를(residual magnetization) 최소화하기 위하여 삼차원 경사자장(crusher gradients)만을 사용하였다. 따라서 6개의 텐서 성분을 단 한번의 실험에 의하여 얻을 수 있었다. 이 시퀀스를 사용하여 물과 수박을 이용하여 실험을 하였으며 물에서의 확산 값이 기존에 출판된 값과 유사하게 나타나 본 연구에서 MePGSE 시퀀스의 신뢰를 가질 수 있었다.

• Journal of Magnetics
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• 제22권1호
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• pp.146-149
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• 2017

In this study, we compared the standardized value of each signal intensity, the apparent diffusion coefficient (ADC) that digitizes the diffusion of water molecules, and the signal to noise ratio (SNR) using b value 0 400, 1400 ($s/mm^2$). From March 2013 to December 2013, patients with suspicion of simple compound fracture and metastatic spine cancer were included in the MR readout. We used a 1.5 Tesla Achieva MRI system and a Syn-Spine Coil. Sequence is a DWI SE-EPI sagittal (diffusion weighted imaging spin echo-echo planar imaging sagittal) image with b-factor ($s/mm^2$) 0, 400, 1400 were used. Data analysis showed ROI (Region of Interest) in diseased area with high SI (signal intensity) in diffusion-weighted image b value 0 ($s/mm^2$) Using the MRIcro program, each SI was calculated with images of b-value 0, 400, and 1400 ($s/mm^2$), ADC map was obtained using Metlab Software with each image of b-value, The ADC is obtained by applying the ROI to the same position. The standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of simple compression fractures were $0.47{\pm}0.04$ and $0.23{\pm}0.03$ and the standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of the metastatic spine were $0.57{\pm}0.07$ and $0.32{\pm}0.08$ And the standardized values of the two diseases were statistically significant (p < 0.05). The ADC ($mm^2/s$) for b value 400 ($s/mm^2$) and 1400 ($s/mm^2$) of the simple compression fracture disease site were $1.70{\pm}0.16$ and $0.93{\pm}0.28$ and $1.24{\pm}0.21$ and $0.80{\pm}0.15$ for the metastatic spine. The ADC ($mm^2/s$) for b value 400($s/mm^2$) was statistically significant (p < 0.05) but the ADC ($mm^2/s$) for b value 1400 (p > 0.05). In conclusion, multi - b value recognition of signal changes in diffusion - weighted imaging is very important for the diagnosis of various spinal diseases.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2006년도 제11차 학술대회
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• pp.48-48
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• 2006

• Investigative Magnetic Resonance Imaging
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• 제25권2호
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• pp.76-80
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• 2021

Post-concussion syndrome (PCS) following mild traumatic brain injury (mTBI) is a major factor that contributes to the increased socioeconomic burden caused by TBI. Myelin loss has been implicated in the development of PCS following mTBI. Diffusion tensor imaging (DTI), a traditional imaging modality for the evaluation of axonal and myelin integrity in mTBI, has intrinsic limitations, including its lack of specificity and its time-consuming and labor-intensive post-processing analysis. More recently, various fast MR techniques based on multicomponent relaxometry (MCR), including QRAPMASTER, mcDESPOT, and MDME sequences, have been developed. These MCR-based sequences can provide myelin water fraction/myelin volume fraction, a quantitative parameter more specific to myelin, which might serve as a surrogate marker of myelin volume, in a clinically feasible time. In this review, we summarize the clinical application of the MCR-based fast MR techniques in mTBI patients.

• 한국콘텐츠학회:학술대회논문집
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• 한국콘텐츠학회 2018년도 춘계 종합학술대회 논문집
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• pp.61-62
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• 2018

DTI (Diffusion Tensor Imaging)에서는 임상적으로 매우 중요하나 긴 획득시간으로 인하여 적용에 어려움이 있었다. 그러나 최근에 개발된 다중대역병렬기법 (Multiband SENSE)은 동시에 여러 개의 절편을 획득이 가능한 기법으로 기존에 사용되는 병렬기법(SENSE)과 비교하여도 매우 유용한 것을 알 수 있다.