• The Journal of Korean Physical Therapy
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• v.22 no.5
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• pp.109-115
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• 2010

Purpose: This study was to delineate the structural change of neural pathway after sequential motor learning using diffusion tensor imaging (DTI). Methods: The participants were 16 healthy subjects, which were divided by training (n=8) and control (n=8) group. The task for the training was the Serial Reaction Time Task (SRTT) which was designed by Superlab program. When the 'asterisk' shows up in the 4 partition spaces on the monitor, the subject presses the correct response button as soon as possible. The training group participated in the training program of motor learning with SRTT composed of 24 digits pattern in one hour per daily through 10 days during 2 weeks. Results: In the behavioral results the training group showed significant changes in the increase of response number and the reduction of response time than those of the control group. There was significant difference in the left inferior frontal area in the fractional anisotropy (FA) map of the training group in DTI analysis. Conclusion: Motor sequential learning as like SRTT may be needed to the learning of language and visuospatial processing and may be induced for the experience-dependent structural plasticity during short period.

• Clinical and Experimental Pediatrics
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• v.54 no.1
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• pp.40-44
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• 2011

We present a case of tacrolimus-induced encephalopathy after successful kidney transplantation. An 11-year-old girl presented with sudden onset of neurologic symptoms, hypertension, and psychiatric symptoms, with normal kidney function, after kidney transplantation. The symptoms improved after cessation of tacrolimus. Magnetic resonance imaging (MRI) showed acute infarction of the middle cerebral artery (MCA) territory in the right frontal lobe. Three days later, she had normal mental function and maintained normal blood pressure with left hemiparesis. Follow-up MRI was performed on D19, showing new infarct lesions at both cerebral hemispheres. Ten days later, MRI showed further improvement, but brain single photon emission computed tomography (SPECT) showed mild reduction of uptake in both the anterior cingulate gyrus and the left thalamus. One month after onset of symptoms, angiography showed complete resolution of stenosis. However, presenting as a mild fine motor disability of both hands and mild dysarthria, what had been atrophy at both centrum semiovale at 4 months now showed progression to encephalomalacia. There are two points of interest in this case. First, encephalopathy occurred after administration of tacrolimus and improved after discontinuation of the drug. Second, the development of right-side hemiplegia could not be explained by conventional MRI; but through diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) of white matter tract, visualization was possible.

• The Journal of Korean Physical Therapy
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• v.34 no.6
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• pp.326-331
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• 2022

Purpose: The stroke patients have gait dysfunction due to impaired neural tracts; corticospinal tract (CST), corticoreticular pathway (CRP), and vestibulospinal tract (VST). In this study, we investigated characteristics of gait pattern according to the injury aspect of the neural track in a stroke patient. Methods: One patient and six control subjects of similar age participated. A 19-year-old male patient with spontaneous intracerebral hemorrhage on right basal ganglia, thalamus, corona radiata and cerebral cortex due to arteriovenous malformation rupture. Diffusion tensor imaging (DTI) data was acquired 21 months after the stroke. Kinematic and spatio-temporal parameters of gait were collected using a three-dimensional gait analysis system. Results: On 21 months DTI, the CST and CRP in affected hemisphere showed severe injury, in contrast, the VST in affected hemisphere showed intact integrity. Result of gait analysis, walking distance and speed were significantly decreased in a patient. The stance rate of unaffected lower limb, the swing rate of affected lower limb and the duration of double stance significantly increased compared with normal control. The knee and hip joint angle were significantly decreased in a patient. Conclusion: We found recovered independent gait ability may be associated with unimpaired VST in a patient with severe injury in CST and CRP.

• Korean Journal of Radiology
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• v.24 no.6
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• pp.553-563
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• 2023

Objective: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. Materials and Methods: This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. Results: Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). Conclusion: fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.

• Journal of Biomedical Engineering Research
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• v.25 no.1
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• pp.43-47
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• 2004

Interests in human brain functionality and its connectivity have much frown up. DTI (Diffusion tensor imaging) has been known as a non-invasive MR) technique capable of providing information on water diffusion in tissues and the organization of white matter tract. Thus. It can provide us the information on the direction of brain fiber tract and the connectivity among many important cortical regions which can not be examined by other anatomical or functional MRI techniques. In this study. was used the 24 bit color coding scheme on the IDL platform in the windows environment to visualize the orientation of major fiber tracts of brain such as main association, projection, commissural fibers and corticospinal tracts. We additionally implemented a color coding scheme for each directional component and FA (fractional anisotropy), and used various color tables for them to be visualized more definitely. Consequently we implemented a fancy and basic technique to visualize the directional information of fiber tracts efficiently and we confirmed the feasibility of the 24 bit color coding scheme in DTI by visualizing main fiber tracts.

• Journal of the Korean Society of Radiology
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• v.10 no.1
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• pp.7-13
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• 2016

The goal of this study is to investigate corpus callosum and both internal capsule changes with the internet addiction disorder compared to control group using MR diffusion tensor imaging. A total of 22 teenager volunteers who had 10 high-risk group with internet addiction and 12 normal control group were conducted for this study. Imaging was conducted on a 3 T using a EPI sequence. Image evaluation was analysed of the FA, ADC($10^{-3}mm^2/s$), length(mm). We did select ROI for image tracking on corpus callosum of 5 and including 2(internal capsule). The data from these ROIs were compared statistically among the groups using independent t-test, correlation coefficient. There were significant inter-group differences(p<0.05) among FA, ADC($10^{-3}mm^2/s$) and length(mm). And also significantly negative correlations were fond between FA values of corpus callosum and IAD scale(p=0.000). DTI was shown significant changes of FA and ADC, LNF values in IAD compared to control group. Therefore, our results may provided clinical information for brain wite matter functions.

• Journal of Biomedical Engineering Research
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• v.28 no.6
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• pp.817-824
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• 2007

Tractography using Diffusion Tensor Magnetic Resonance Imaging (DT-MRI) is a method to determine the architecture of axonal fibers in the central nervous system by computing the direction of the principal eigenvector in the white matter of the brain. However, the fiber tracking methods suffer from the noise included in the diffusion tensor images that affects the determination of the principal eigenvector. As the fiber tracking progresses, the accumulated error creates a large deviation between the calculated fiber and the real fiber. This problem of the DT-MRI tractography is known mathematically as the ill-posed problem which means that tractography is very sensitive to perturbations by noise. To reduce the noise in DT-MRI measurements, a tensor-valued median filter which is reported to be denoising and structure-preserving in fiber tracking, is applied in the tractography. In this paper, we proposed the modified gradient descent method which converges fast and accurately to the optimal tensor-valued median filter by changing the step size. In addition, the performance of the modified gradient descent method is compared with others. We used the synthetic image which consists of 45 degree principal eigenvectors and the corticospinal tract. For the synthetic image, the proposed method achieved 4.66%, 16.66% and 15.08% less error than the conventional gradient descent method for error measures AE, AAE, AFA respectively. For the corticospinal tract, at iteration number ten the proposed method achieved 3.78%, 25.71 % and 11.54% less error than the conventional gradient descent method for error measures AE, AAE, AFA respectively.

• Investigative Magnetic Resonance Imaging
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• v.24 no.3
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• pp.174-177
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• 2020

Multiple studies have established that mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) exhibits reversible diffusion restriction in the white matter, including the splenium. There have been a few previous reports of the change in fractional anisotropy (FA) of MERS cases. Herein, we report the longitudinal changes in axial and radial diffusivity (AD and RD), and FA in a 15-year-old boy patient with MERS. Our case demonstrated that a MERS lesion had a significant drop of AD in the early period and gradual recovery. On the contrary, RD did not show any significant change.

• PNF and Movement
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• v.12 no.3
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• pp.143-150
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• 2014

Purpose: The corticospinal tract (CST) is known to be an important pyramidal tract for walking and motor function. However, very little is known about the functional role of the CST in the recovery of motor function. In the current study, we investigated the relation between the CST and motor function in chronic hemiparetic stroke patients. Methods: Fifty-four patients and 20 normal subjects were recruited. The Functional Ambulation Category (FAC) was used in measurement of the walking ability. We classified patients into three groups according to the ability to walk independently: group A, patients who could not walk independently (FAC: 0-2); group B, patients who could walk independently (FAC: 3); and group C, patd walk functionally (stairs and uneven surfaces, FAC 4-5). The Motricity Index (MI) was used to measure the motor function of the affected upper and lower extremities (maximum score: 100). The fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value, and fiber volume of the CST were used for the diffusion tensor imaging (DTI) parameters. Results: In terms of the CST of the unaffected hemisphere, the FA value of group A was significantly lower than that of normal controls (p <0.05). The fiber volume of group C was significantly higher than that of normal controls (p <0.05). In contrast, the ADC values of all patient groups and the control group did not show any difference (p >0.05). In terms of lower MI and total MI, significant differences were observed between all patient groups (p <0.05). In addition, significant differences in terms of the upper MI scores were observed between groups A and C and between groups B and C (p <0.05); however, no significant difference was observed between groups A and B (p>0.05). Conclusion: The increased fiber volume of the CST in the unaffected hemisphere appears to be related to functional walking ability in chronic stroke patients. This result would be useful for elucidation of the neural recovery mechanism of walking and the investigation of new modalities for the recovery of walking following a stroke with CST injury.

• Brain Tumor Research and Treatment
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• v.6 no.2
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• pp.60-67
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• 2018

Background Recently, modern technology such as diffusion tensor imaging (DTI), neuro-navigation and intraoperative neurophysiological monitoring (IOM) have been actively adopted for the treatment of thalamic tumors. We evaluated surgical outcomes and efficacy of the aforementioned technologies for the treatment of pediatric thalamic tumors. Methods We retrospectively reviewed clinical data from 37 children with thalamic tumors between 2004 and 2017. There were 44 operations (27 tumor resections, 17 biopsies). DTI was employed in 17 cases, neuro-navigation in 23 cases and IOM in 14 cases. All diagnoses were revised according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Progression-free survival (PFS) and overall survival (OS) rates were calculated, and relevant prognostic factors were analyzed. The median follow-up duration was 19 months. Results Fifteen cases were gross total resections (GTR), 6 subtotal resections (STR), and 6 partial resections (PR). Neurological status did not worsen after 22 tumor resections. There were statistically significant differences in terms of the extent of resection between the groups with DTI, neuro-navigation and IOM (n=12, GTR or STR=12) and the group without at least one of the three techniques (n= 15, GTR or STR=9, p=0.020). The mean PFS was $87.2{\pm}38.0$ months, and the mean OS $90.7{\pm}36.1$ months. The 5-year PFS was 37%, and the 5-year OS 47%. The histological grade ($p{\leq}0.001$) and adjuvant therapy (done vs. not done, p=0.016) were significantly related to longer PFS. The histological grade (p=0.002) and the extent of removal (GTR/STR vs. PR/biopsy, p=0.047) were significantly related to longer OS. Conclusion Maximal surgical resection was achieved with acceptable morbidity in children with thalamic tumors by employing DTI, neuro-navigation and IOM. Maximal tumor resection was a relevant clinical factor affecting OS; therefore, it should be considered the initial therapeutic option for pediatric thalamic tumors.