• Clinical and Experimental Pediatrics
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• 제54권1호
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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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• 제34권6호
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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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• 제24권6호
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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.

• 대한의용생체공학회:의공학회지
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• 제25권1호
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• pp.43-47
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• 2004

뇌의 기능성과 분산 영역간의 연결성에 대한 관심이 매우 증대되고 있는 추세다. 그 중에서 DTI (확산 텐서 영상)는 비침습적으로 뇌에서의 물분자의 확산과 뇌의 회백질 신경 다발 구조에 대한 정보를 제공할 수 있는 자기공명영상 기법이다. 따라서 우리는 이 기법을 통해 다른 해부학적 혹은 기능적 자기공명영상 기법으로는 얼을 수 없는 뇌의 신경 섬유 다발과 대뇌 피질 영역의 연결성 정보를 얻을 수 있다. 본 연구에서는 컬러 코딩 방식에 의하여 뇌의 주된 신경 다발의 방향성을 가시화 하고자 한다. 인간 뇌의 방향성 지도는 연합섬유, 방사섬유. 교련섬유. 운동 및 감각회로 섬유의 다발들을 구별하기 쉽게 하여준다. 우리는 이 목적 하에 24비트 칼라코딩 방법을 윈도우 PC 환경에서 IDL을 이용하여 구현하였다. 덧붙여 방향성의 각각의 성분 및 이방성에 대한 컬러 코딩과 이들을 표현하기 위한 다양한 색상표를 구현하였다. 결론적으로 우리의 24 비트 킬러 코딩을 이용한 뇌 회백질의 신경 다발의 방향성 가시화에 성공하였다. 우리가 구현한 방법에 의해 뇌의 주요 신경 다발들이 잘 가시화됨을 확인하였다.

• 한국방사선학회논문지
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• 제10권1호
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• pp.7-13
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• 2016

3.0 T 자기공명영상기기에서 확산텐서영상을 이용하여 청소년을 대상으로 정상인과 인터넷 중독자의 뇌량과 내섬유막 구조의 변화에 대하여 정량적으로 알아보고자 하였다. 10명의 인터넷 중독자와 정상인 12명을 대상으로 검사를 하였고, 정량적 분석을 위하여 뇌량의 5부위와 내섬유막의 2부위를 View Forum 프로그램을 이용하여 두 그룹에 대한 신경섬유의 손상 정도를 FA, ADC($10^{-3}mm^2/s$), Length(mm)값으로 측정하였다. 그룹 간 통계적 유의성은 Independent t-test와 pearson 상관관계로 하였다(p<0.05). 정상인과 인터넷 중 독자에 관하여 신경섬유 손상정도는 7부위에 대하여 FA, ADC($10^{-3}mm^2/s$), Length(mm)값에 대하여 의미 있는 차이를 보였다(p<0.05). 또한 두 그룹에서 IAD scale 과 뇌량의 FA값은 음의 적으로 강하게 상관관계가 있었다(p<0.000). 결론적으로, 확산텐서영상은 FA, ADC($10^{-3}mm^2/s$), Length(mm)값에 대하여 유의성 있는 차이를 보여고, 이 결과는 뇌 백질에 대한 손상정도에 관하여 정량적으로 임상적 정보를 제공하였다.

• 대한의용생체공학회:의공학회지
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• 제28권6호
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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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• 제24권3호
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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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• 제12권3호
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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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• 제6권2호
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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.

• The Journal of Korean Physical Therapy
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• 제25권3호
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• pp.132-135
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• 2013

We presented with a patient who showed injury of the cingulum and fornix by penetration of a foreign body into the brain on diffusion tensor tractography (DTT). A 63-year-old man suffered a brain injury by a part of a power saw blade that was suddenly detached from a power saw during work. A part of the power saw blade penetrated his right frontal skull and advanced to the right posterior horn of the lateral ventricle. This penetration caused traumatic intracerebral hemorrhage in the right frontal lobe and intraventricular hemorrhage in the lateral ventricle. He underwent craniotomy and removal of intracranial foreign bodies (bony pieces and saw blade). The patient's Memory Assessment Scale scores were 74 (4%ile) for global memory, 78 (7%ile) for verbal memory, and 80 (9%ile) for visual memory. DTTs showed disruptions in the anterior portion of the fornical body, right fornical crus, the anterior portion of the right cingulum, and the middle portion of the left cingulum, compared to the control. It seems that the sustained memory impairment of this patient might be related to injury of the cingulum and fornix.