• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.111-118
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• 2012

Purpose: The nasal bone fracture is known as the most common facial fracture, with the postoperative results and the patient's satisfaction known to be lower than other facial fractures. The patient's satisfaction is firstly related to the accurate comprehension of the spatial relationship in the fractured nasal bone and secondly to the accurate reduction based on accurate comprehension. The aim of this study is to evaluate the objective usefulness of the three-dimensional (3D) imaging. Methods: The survey was conducted on 10 randomly selected cases of nasal bone fractures among the 46 cases with 3D computed tomography (CT) during the past one year. It was requested upon 4 plastic residents and 4 plastic surgeons to draw 3D aspect of fractured nasal bone directly on the printed photos of cadaver nasal bone, based on simple X-ray and two-dimensional (2D) CT. They were compared with the real fractured nasal bone aspects based on the 3D image and marked the difference in the 10-point scale of 0 to 10. Results: The average score of the 4 residents was 1.62 and that of the 4 surgeons was 4.47 out of 10 by simple X-ray. The average score of the 4 residents was 5.67 and that of the 4 surgeons was 7.25 out of 10 by 2D CT. Conclusion: It was surmised that the precise analysis and accurate comprehension of the spatial relationship of the fractured nasal bone using the 3D image, as based on the 2D CT images, can produce more favorable satisfaction levels in the patients.

• 핵의학기술
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• 제19권1호
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• pp.12-16
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• 2015

주성분분석(Principal component analysis, PCA)은 고차원 변수들 사이의 복잡한 상관성 구조를 더 낮은 차원으로 단순화하여 상관성의 구조를 쉽게 설명하기 위한 다변량분석기법으로 뇌영상 분석에서 자주 사용되는 방법이다. 주성분분석의 기본개념은 서로 직교하는 변수들의 선형결합을 통해서 원래의 뇌영상 자료가 가지고 있는 전체정보를 최대한 설명할 수 있는 서로 독립적인 새로운 변수들을 유도하는 것이다. 뇌영상분석에서 주성분분석의 효율성과 유용성을 알아보기 위해서 C[11]-PIB 영상을 이용하여 분석하였다. 대상 및 방법으로는 평균나이가 같은 9명의 정상인, 10명의 알츠하이머/경도인지장애환자들의 C[11]-PIB 영상을 이용하였다. PET-CT 장비로는 Biograph 6 Hi-Rez (Siemens-CTI, Knoxville, TN)를 영상을 획득하였고 9.6 MBq/kg C[11]-PIB를 정맥주사 한 후 40분 후에 20분 동안 3D acquisition mode로 방출영상을 얻었다. Attenuation map은 X-ray CT scan을 이용하여 재구성하였다(130 kVp, 240 mA). PIB template을 만들기 위해서 정상인에서 3T MRI T1-weighted 영상을 동시에 얻었다. 주성분분석을 위한전처리과정으로서 공간정규화 및 공간편평화를 SPM8을 이용하여 실시하였고 주성분분석은 Matlab2012b를 이용하여 분석하다. 결과는 주성분분석을 통해서 서로 독립적인 주성분영상들을 얻을 수 있었다. 주성분분석을 통해서 얻어진주성분영상은 C[11]-PIB brain PET 영상의 패턴을 몇 개의 주성분으로 단순화 할 수 있었으며 주로는 neocortex를 변동 나타내는 영상, white matter의 변동을 나타내는 영상 그리고 pons등 deep brain의 변동을 나타내는 영상 등으로 단순화되었다. 결론으로는 주성분분석은 C[11]-PIB brain 영상을 단순화하여 영상의 패턴을 해석하는데 매우 유용하였다. 이러한 주성분분석은C[11]-PIB영상 분석뿐만 아니라 뇌의 포도당 대사를 측정하는 FDG-PET 또는 뇌기능영상등의 다변량분석 방법으로서 그 적용범위가 클 것으로 기대된다.

• Clinical and Experimental Pediatrics
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• 제52권1호
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• pp.99-104
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• 2009

목 적 : 편마비를 가진 뇌성마비 환아에서 확산 텐서강조영상을 이용한 3차원 피질척수로 영상의 이상 소견의 유형과 임상적인 소견과의 일치도를 알아보기 위하여 연구를 시행하였다. 방 법 : 2003년 3월부터 2007년 8월까지 영남대학교 의과대학 부속병원 소아과 및 재활의학과에서 확산 텐서강조영상 검사를 시행했던 편마비를 가진 뇌성마비 환아 13예를 대상으로 FACT기법을 사용하여 피질척수로의 3차원 신경섬유로 영상을 재구성하여 분석하였다. 기본 관심영역은 전 뇌교, 두 번째 관심영역은 전 수질을 통과하는 피질척수로로 설정하여 두 부위를 동시에 통과하는 신경섬유로를 최종 관심 신경섬유로로 하였다. 분할비등방도와 각의 종료 기준은 각각 0.3과 70도로 하였다. 결 과 : 삼차원 피질척수로 영상에서 이상 소견으로는 피질척수로의 단절과 신경섬유의 양적 감소, 피질척수로의 무형성, 횡뇌량 신경섬유 그리고 비정상적인 피질척수로의 재구성 등의 유형이 있었으며 전체 13예 중 피질척수로의 단절이 10예(76.9%), 신경섬유의 양적 감소가 8예(61.5%)에서 관찰되었다. 피질척수로의 무형성은 3예(23.1%)에서 관찰되었고 횡뇌량 신경섬유로는 2예(15.4%), 비정상적인 피질척수로의 재구성은 4예(30.8%)에서 관찰되었다. 임상적인 소견과 3차원 피질척수로의 이상소견이 일치되는 예가 13예 중 11예(84.6%)였다. 결 론 : 확산 텐서강조영상을 이용한 3차원 피질척수로 영상은 다양한 이상 소견과 임상적인 소견과의 높은 일치도를 보여 편마비 뇌성마비의 진단과 치료에 매우 유용한 검사로 사용될 수 있다고 생각된다. 그러나 향후 검사법의 표준화 등 보완을 요하는 연구가 더 필요하다고 생각된다.

• Radiation Oncology Journal
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• 제30권2호
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• pp.53-61
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• 2012

Purpose: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. Materials and Methods: Nine patients with multiple (${\geq}4$) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. Results: The median biologically effective dose to metastatic tumors was 68.1 $Gy_{10}$ and 67.2 $Gy_{10}$ and the median brain volume irradiated more than 100 $Gy_3$ were 1.9% (24 $cm^3$) and 0.8% (13 $cm^3$) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. Conclusion: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

• Investigative Magnetic Resonance Imaging
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• 제19권2호
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• pp.76-87
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• 2015

Purpose: There is an ongoing search for a stent material that produces a reduced susceptibility artifact. This study evaluated the effect of manganese (Mn) content on the MRI susceptibility artifact of ferrous-manganese (Fe-Mn) alloys, and investigated the correlation between MRI findings and measurements of Fe-Mn microstructure on X-ray diffraction (XRD). Materials and Methods: Fe-Mn binary alloys were prepared with Mn contents varying from 10% to 35% by weight (i.e., 10%, 15%, 20%, 25%, 30%, and 35%; designated as Fe-10Mn, Fe-15Mn, Fe-20Mn, Fe-25Mn, Fe-30Mn, and Fe-35Mn, respectively), and their microstructure was evaluated using XRD. Three-dimensional spoiled gradient echo sequences of cylindrical specimens were obtained in parallel and perpendicular to the static magnetic field (B0). In addition, T1-weighted spin echo, T2-weighted fast spin echo, and $T2^*$weighted gradient echo images were obtained. The size of the low-intensity area on MRI was measured for each of the Fe-Mn binary alloys prepared. Results: Three phases of ${\alpha}^{\prime}$-martensite, ${\gamma}$-austenite, and ${\varepsilon}$-martensite were seen on XRD, and their composition changed from ${\alpha}^{\prime}$-martensite to ${\gamma}$-austenite and/or ${\varepsilon}$-martensite, with increasing Mn content. The Fe-10Mn and Fe-15Mn specimens comprised ${\alpha}^{\prime}$-martensite, the Fe-20Mn and Fe-25Mn specimens comprised ${\gamma}+{\varepsilon}$ phases, and the Fe-30Mn and Fe-35Mn specimens exhibited a single ${\gamma}$ phase. The size of the low-intensity areas of Fe-Mn on MRI decreased relative to its microstructure on XRD with increasing Mn content. Conclusion: Based on these findings, proper conditioning of the Mn content in Fe-Mn alloys will improve its visibility on MR angiography, and a Mn content of more than 25% is recommended to reduce the magnetic susceptibility artifacts on MRI. A reduced artifact of Fe-Mn alloys on MRI is closely related to the paramagnetic constitution of ${\gamma}$-austenite and/or ${\varepsilon}$-martensite.

• Radiation Oncology Journal
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• 제18권2호
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• pp.107-113
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• 2000

목적 : 간암의 3차원 입체조형치료계획시 electronic portal imaging device (EPID)를 이용한 검증영상으로 경계여유 결정에 필요한 객관적 기초자료를 얻으므로써 방사선치료의 정확성을 높이고 본 기기를 이용하여 방사선치료의 정도관리 측면에서의 유용성을 알아보고자 하였다. 대상 및 방법: 10명의 간암 환자에서 EPID를 이용하여 1회 방사선 치료 중 약 4극회의 검증영상을 획득하였고 총 10회 분할 치료기간 동안 반복하여 시행하였다. 방사선치료 자세 고정시 발생할 수 있는 각 개인의 자세 오차를 구하여 치료간 발생하는 환자의 위치 이동을 분석하였고, 호흡으로 인한 간의 상하 움직임의 정도를 측정하여 계획용표적체적(Planning Target Volume, PTV)의 결정시 필요한 적정 경계 여유를 구하였다. 결과 : 검증영상 분석 결과 간암의 치료시 자세이동에 의한 자세 오차는 x축으로 3.0 mm, 표준편차는 1.70 mm 였고 y축으로 3.7 mm, 표준편차 1.88 mm 였다. 따라서 각 축을 중심으로 5 mm 이내였다. 또한 호흡에 의한 간의 상하 운동 범위는 평균 8.63 mm이었고 표준편차는 1.48 mm 였다. 따라서 계획용표적체적 결정시 종양에 적어도 15 mm의 경계여유가 더 필요하다 결론 : EPID는 3차원 입체조형치료계획시 종양의 경계여유 결정에 매우 유용하며 나아가서 방사선치료의 정도관리에도 크게 기여할 것이다

• Investigative Magnetic Resonance Imaging
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• 제17권4호
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• pp.275-285
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• 2013

목적: 본 연구의 목적은 자화감수성 영상 (SWI)에 나타난 정상 노인의 뇌조직을 픽셀 별로 분석하기 위해 사용되는 다듬질 (smoothing)의 핵심 크기 효과를 보는 것이다. 대상과 방법: 이십 명의 정상 지원군 (평균 나이${\pm}$ 표준 편차 = $67.8{\pm}6.09$세, 여 14명, 남 6명) 이 실험에 대한 동의와 함께 본 연구에 참여하였다. 이 지원군 각각의 자화감수성 영상을 만들기 위해 일차원 혈류흐름 보상 삼차원 경사자장 에코 시퀀스를 이용해 크기과 위상 영상을 얻었고, 영상 처리와 영상 내 조직 분할에 사용되는 자화준비 급속획득 경사자장 에코 (MPRAGE) 시퀀스를 이용한 삼차원 시상면 T1 강조영상을 얻었다. 자화감수성 영상은 다시 위상영상을 이용하여 상자성 (paramagnetic) 물질의 존재 여부를 강조하는 PSWI (위상 영상에서 양수 값을 강조한 자화감수성 영상)과 반자성 (diamagnetic) 물질의 존재 여부를 강조하는 NSWI (위상 영상의 음수 값을 강조한 자화감수성 영상) 영상을 만들었다. 오직 뇌조직 부분만 나타나도록 조직이 아닌 부분을 차폐 (masking) 하는 과정을 거쳤다. 마지막으로 뇌조직 PSWI와 NSWI는 등방성의 0, 2, 4, 8 mm의 다듬질 핵심 크기를 이용하여 다듬질 되었다. 또한 각각의 다듬질 핵심 크기로 다듬질된 PSWI와 NSWI를 쌍 비교 t검정을 실행하여 각 픽셀 별로 비교하였다. 결과: 통계 분석의 중요도는 다듬질의 핵심 크기가 커질수록 증가하였고, 영상의 시그널 세기는 NSWI가 PSWI보다 컸다. 또한 영상의 픽셀 별 비교 분석에 가장 최적화 된 다듬질의 핵심 크기는 4였으며 쌍 비교 t검정 결과 뇌의 양쪽에서 차이가 난 뇌 조직의 위치와 범위는 뇌의 여러 지역에서 발견되었다. 결론: 상자성 물질을 강조한 PSWI는 자화감수성이 높은 뇌 여러 영역의 시그널 크기를 감소시켰다. 부분적인 부피효과와 큰 혈관의 기여도를 최소화 하기 위해서는 뇌 조직만 뽑아낸 자화감수성 영상의 복셀 별 분석이 사용되어야 하겠다.

• Radiation Oncology Journal
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• 제29권3호
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• pp.147-155
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• 2011

Purpose: This study was designed to determine the influencing factors and clinical course of pathologically proven cases of radiation-induced brain injury (RIBI). Materials and Methods: The pathologic records of twelve patients were reviewed; these patients underwent surgery following radiotherapy due to disease progression found by follow-up imaging. However, they were finally diagnosed with RIBI. All patients had been treated with 3-dimensional conventional fractionated radiotherapy and/or radiosurgery for primary or metastatic brain tumors with or without chemotherapy. The histological distribution was as follows: two falx meningioma, six glioblastoma multiform (GBM), two anaplastic oligodendroglioma, one low grade oligodendroglioma, and one small cell lung cancer with brain metastasis. Results: Radiation necrosis was noted in eight patients and the remaining four were diagnosed with radiation change. Gender (p = 0.061) and biologically equivalent dose $(BED)_3$ (p = 0.084) were the only marginally influencing factors of radiation necrosis. Median time to RIBI was 7.3 months (range, 0.5 to 61 months). Three prolonged survivors with GBM were observed. In the subgroup analysis of high grade gliomas, RIBI that developed <6 months after radiotherapy was associated with inferior overall survival rates compared to cases of RIBI that occurred ${\geq}6$ months (p = 0.085). Conclusion: Our study demonstrated that RIBI could occur in early periods after conventional fractionated brain radiotherapy within normal tolerable dose ranges. Studies with a larger number of patients are required to identify the strong influencing factors for RIBI development.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권6호
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• pp.461-468
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• 2009

Purpose: Platelet derived growth factor(PDGF)-BB and bone morphogenetic protein(BMP)-2 are well-known representative growth factors. The purposes of this study were to investigate the effect of rhPDGFBB and rhBMP-2 on osseointegration of titanium implants at periimplant bone defects grafted with hydroxyapatite and to evaluate the feasibility of imaging bone structures around screw-type titanium implant with micro-CT. Materials and Methods: The first molar and all premolars in the mandible region of four beagle dogs were extracted. Following a healing period of 4 months, three $8{\times}8{\times}6mm$-sized bony defects were formed and screw-type titanium implants were placed with hydroxyapatite(HA) block and growth factors; Control group, PDGF group and BMP group. Two months post-implantation, the mandible was harvested. Bone volume(BV), bone-to-implant contact(BIC) and bone mineral density(BMD) were analyzed with micro-CT and histology. Results: According to micro-CT analysis, BV and BMD measures of PDGF and BMP group were significantly higher than control group(BV; PDGF group: $p{\fallingdotseq}0.011$, BMP group: $p{\fallingdotseq}0.006$/BMD; PDGF group: $p{\fallingdotseq}0.020$, BMP group: $p{\fallingdotseq}0.011$) and BIC measures of BMP group were significantly higher than PDGF group($p{\fallingdotseq}0.015$). In histologic evaluation, BIC measures of BMP group was significantly higher than PDGF group($p{\fallingdotseq}0.048$). The values of BV in histologic sections were higher than in micro-CT images and the values of BIC in micro-CT images were higher than in histologic sections. Conclusion: The findings of this experimental study indicates that the use of rhPDGF-BB and rhBMP-2 can increase new bone formation in a large bony defect around titanium implant, and rhBMP-2 is more effective than rhPDGF-BB. Micro-CT can be considered useful for assessment as a rapid and nondestructive method for 3-dimensional measurement of bone healing around implants. Further study is necessary, however, to remove metal artifacts around titanium implant and to standardize the method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권6호
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• pp.566-574
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• 2006

Purpose : This study was performed to provide an anatomical information of the mandibular ramus for the successful inferior alveolar nerve block. Three dimensional images were reconstructed from the computerized tomography (CT) and the anatomical evaluation of the mandibular ramus was done. Materials and methods : Sixty-four patients who had been taken the facial CT scans from 2000, Jan to 2003, June was selected. The patients who had the anterior or posterior teeth misssing, edentulous ridge, and jaw fracture were excepted. In the occulusal plane, the lingual surface angle (LSA) between the mid-sagittal plane and the mandibular molar lingual surface from the 2nd premolar to the 2nd molar, the inner ramal surface angle (IRSA), the maximum inner ramal surface angle (MxIRSA), and the outer ramal surface angle (ORSA) to the-mid sagittal plane were measured. The inner ramal surface angle in the ligular tip level (IRSA-L) and the outer ramal surface angle in the ligular tip level (ORSA-L), the ramal length (RL), and the anterior ramal length (ARL) were also measured in the lingular tip level. Results : In the lingular tip level, the mean IRSA-L and ORSA-L were $28.6{\pm}6.3^{\circ}$ and $17.9{\pm}4.9^{\circ}$ respectively. The larger was the IRSA, the larger was the ORSA. In the lingular tip level, the mean ramal length was 35.8${\pm}$3.4 mm. The larger was the IRSA-L, the shorter was the ramal length. On the lingular tip level, the mean anterior ramal length from anterior ramus to lingular tip was 19.6${\pm}$3.3 mm. when the ramal length was longer, the anterior ramal length was also longer. On the lingular tip level, there was positive correlation vetween the IRSA and the ORSA, negative correlation between the IRSA and the ramal length, and positive correlation between the ramal length and the lingular tip level to the anterior ramus. There was no statistical meaning of data between sex and age. Conclusion : In the clinical view of the results so far achieved, if the direction of needle is closer to posterior it is able to contact bone on lingular tip when the internal surface of ramus is wided outer.