• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.26-32
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• 2014

Purpose: As PET-MRI which has excellent soft tissue contrast is developed as integration system, many researches about clinical application are being conducted by comparing with existing display equipments. Because PET-MRI is actively used for head and neck cancer diagnosis in our hospital, lymph node metastasis before the patient's surgery was diagnosed and clinical usefulness of head and neck cancer PET-MRI scan was evaluated using pathological opinions and idiopathy surrounding tissue metastasis evaluation method. Materials and Methods: Targeting 100 head and neck cancer patients in SNUH from January to August in 2013. $^{18}F-FDG$ (5.18 MBq/kg) was intravenous injected and after 60 min of rest, torso (body TIM coil, Vibe-Dixon) and dedication (head-neck TIM coil, UTE, Dotarem injection) scans were conducted using $Bio-graph^{TM}$ mMR 3T (SIEMENS, Munich). Data were reorganized using iterative reconstruction and lymph node metastasis was read with Syngo.Via workstation. Subsequently, pathological observations and diagnosis before-and-after surgery were examined with integrated medical information system (EMR, best-care) in SNUH. Patient's diagnostic information was entered in each category of $2{\times}2$ decision matrix and was classified into true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Based on these classified test results, sensitivity, specificity, accuracy, false negative and false positive rate were calculated. Results: In PET-MRI scan results of head and neck cancer patients, positive and negative cases of lymph node metastasis were 49 and 51 cases respectively and positive and negative lymph node metastasis through before-and-after surgery pathological results were 46 and 54 cases respectively. In both tests, TP which received positive lymph node metastasis were analyzed as 34 cases, FP which received positive lymph node metastasis in PET-MRI scan but received negative lymph node metastasis in pathological test were 4 cases, FN which received negative lymph node metastasis but received positive lymph node metastasis in pathological test was 1 case, and TN which received negative lymph node metastasis in both two tests were 50 cases. Based on these data, sensitivity in PET-MRI scan of head and neck cancer patient was identified to be 97.8%, specificity was 92.5%, accuracy was 95%, FN rate was 2.1% and FP rate was 7.00% respectively. Conclusion: PET-MRI which can apply the acquired functional information using high tissue contrast and various sequences was considered to be useful in determining the weapons before-and-after surgery in head and neck cancer diagnosis or in the evaluation of recurrence and remote detection of metastasis and uncertain idiopathy cervical lymph node metastasis. Additionally, clinical usefulness of PET-MRI through pathological test and integrated diagnosis and follow-up scan was considered to be sufficient as a standard diagnosis scan of head and neck cancer, and additional researches about the development of optimum MR sequence and clinical application are required.

• Journal of the Korean Society of Radiology
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• v.13 no.2
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• pp.217-225
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• 2019

The purpose of this study was to quantitate signal to noise ratio and contrast to noise ratio of the portal vein using CT and 3.0T MRI and to investigate the optimal imaging device. Twenty patients who inspective CT and 3.0T MRI between February 2018 and April 2018 were randomly assigned to receive data from the picture archiving communication system. The SNR and CNR values were evaluated by measuring the mean and standard deviation of the region of interest of the four regions of the portal vein (the main portal vein, the right vein, the left vein, and the middle vein). The results showed that SNR was 9.180.72 in the right context, 9.410.84 in the left context, 9.540.59 in the middle context, 9.550.75 in the order context, and 22.292.03 in the right context and 25.893 in the 3.0T MRI. 19, median context: 24.392.87, and order Mac: 26.642.30 (p<0.05). CNR was 3.790.68 in the CT context, 3.740.65 in the left context, 3.710.39 in the middle context, 3.790.68 in the order context, 9.490.65 in the right context, and 11.0001.90 in the 3.0T MRI, Intermediate context: 12.701.75, order Mac: 10.010.98, 3.0T MRI was higher than CT (p<0.05). In conclusion, SNR and CNR values were higher in the 3.0T MRI than CT in the 4 portal regions. Therefore, 3.0T MRI using non-ionizing radiation was the most superior imaging equipment than CT.

• Imaging Science in Dentistry
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• v.50 no.2
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• pp.93-98
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• 2020

Purpose: Little is known regarding the accuracy of clinical magnetic resonance imaging (MRI) protocols with acceptable scan times in sinus graft assessment. The aim of this study was to evaluate the correlations between MRI and cone-beam computed tomographic (CBCT) measurements of maxillary sinus grafts using 2 different clinical MRI imaging protocols. Materials and Methods: A total of 15 patients who underwent unilateral sinus lift surgery with biphasic calcium phosphate were included in this study. CBCT, T1-weighted MRI, and T2-weighted MRI scans were taken 6 months after sinus lift surgery. Linear measurements of the maximum height and buccolingual width in coronal images, as well as the maximum anteroposterior depth in sagittal images, were performed by 2 trained observers using CBCT and MRI Digital Imaging and Communication in Medicine files. Micro-computed tomography (micro-CT) was also performed to confirm the presence of bone tissue in the grafted area. Correlations between MRI and CBCT measurements were assessed with the Pearson test. Results: Significant correlations between CBCT and MRI were found for sinus graft height (T1-weighted, r=0.711 and P<0.05; T2-weighted, r=0.713 and P<0.05), buccolingual width (T1-weighted, r=0.892 and P<0.05; T2-weighted, r=0.956 and P<0.05), and anteroposterior depth (T1-weighted, r=0.731 and P<0.05; T2-weighted, r=0.873 and P<0.05). The presence of bone tissue in the grafted areas was confirmed via micro-CT. Conclusion: Both MRI pulse sequences tested can be used for sinus graft measurements, as strong correlations with CBCT were found. However, correlations between T2-weighted MRI and CBCT were slightly higher than those between T1-weighted MRI and CBCT.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.222-230
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• 2000

Purpose : Resection of the epileptogenic zone in the parietal and occipital lobes may be relevant although only few studies have been reported. Methods : Eight patients with parietal epilepsy and nine patients with occipital epilepsy were included for this study. Preoperatively, all had video-EEG monitoring with extracranial electrodes, MRI, 3D-surface rendering of MRI using Allegro(ISG Technologies Inc., Toronto, Canada), and PET scans. Sixteen patients underwent invasive recording with subdural grid. Eight had parietal resection including the sensory cortex in two. Seven had partial occipital resection. Two underwent total unilateral occipital lobectomy. The extent of the resection was made based mainly on the data of invasive EEG recordings, MRI, and 3D-surface rendering of MRI, not on the intraoperative electrocorticographic findings as usually done. During resection, electrocortical stimulation was performed on the motor cortex and speech area. Results : Out of eight patients with parietal epilepsy, three had sensory aura, two had gustatory aura, and two had visual aura. Six of nine patients with occipital epilepsy had visual auras. All had complex partial seizures with lateralizing signs in 15 patients. Four had quadrantopsia. One had mild right hemiparesis. Abnormality in MRI was noticed in six out of eight parietal epilepsy and in eight out of nine occipital epilepsy. 3D-surface rendering of MRI visualized volumetric abnormality with geometric spatial relationships adjacent to the normal brain, in all of parietal and occipital epilepsy. Surface EEG recording was not reliable in localizing the epileptogenic zone in any patient. The subdural grid electrodes can be implanted on the core of the structural abnormality in 3D-reconstructed brain. Ictal onset zone was localized accurately by subdural grid EEGs in 16 patients. Motor cortex in nine and sensory speech area in two were identified by electrocortical stimulation. Histopathologic findings revealed cortical dysplasia in 10 patients ; tuberous sclerosis was combined in two, hamartoma and ganglioglioma in one each, and subpial gliosis in six. Eleven patients were seizure free at follow-up of 6 months to 37 months(mean 19.7 months) after surgery. Seizures recurred in two and were unchanged in one. Six produced transient sensory loss and one developed hemiparesis and tactile agnosia. One revealed transient apraxia. Two patients with preoperative quadrantopsia developed homonymous hemianopsia. Conclusion : This study suggests that surgical treatment was relevant in parietal and occipital epilepsies with good surgical outcome, without significant neurologic sequelae. Neuroimaging studies including conventional MRI, 3Dsurface rendering of MRI were necessary in identifying the epileptogenic zone. In particular, 3D-surface rendering of MRI was very helpful in presuming the epileptogenic zone in patients with unidentifiable lesion in the conventional MRI, in planning surgical approach to lesions, and also in making a decision of the extent of the epileptogenic zone in patients with identifiable lesion in conventional MRI. Invasive EEG recording with the subdural grid electrodes helped to confirm a core of the epileptogenic zone which was revealed in 3D-surface rendered brain.

• Journal of the Korean Society of Radiology
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• v.12 no.3
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• pp.335-341
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• 2018

With the improvement of medical state, patients' expectations for the most advanced medical equipment are increasing. Particularly, Magnetic Resonance Image (MRI) is used as one of the core image diagnosis methods in all clinical area. However, it has been reported that many of patients who go through the examination suffer from anxiety to the severe noise level during the examination. In this study, both the noise reduction evaluation of headsets with sound-blocking materials added to existing sound-absorbing materials and the existence of sound blocking materials as artifacts on the examination image are tested. An MRI test noise is recorded as a speaker by cross-ordination the sound material (sponge) and the sound material (acrylic plate, copper plate, and 3D copper plate) inside the headset made from 3D pring. A quantitative assessment of headsets showed that the average headset value was 81.8 dB. The average dB value of the most soundproof material combination(Copper, acrylic plate, sponge, sponge) headsets on headsets with added charactering material was measured at 70.4 dB, and MRI showed that the copper was diamagnetic substance and excluded. The second most soundproof headset(Sponge, acrylic plate, 3D copper plate, sponge) was measured at 70.6 dB and MRI showed no artifacts. The same simulation of the material printed with a 3D copper PLA containing approximately 40 % copper powder resulted in no artifacts, therefore, the material output as a 3D printing was better suited for use. For MRI related research, the mutual development of 3D printing is highly anticipated.

• The Journal of the Korea Contents Association
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• v.17 no.11
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• pp.50-59
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• 2017

To evaluate the capability of integrated PET-MRI, which has recently been utilized in the clinical practices, on the diagnosis of liver cancer, its utility was assessed by $2{\times}2$ decision matrix. The numbers of abnormal and normal decisions on the liver cancer were 98 and 51 cases, respectively, upon PET-MRI scan results of the subjects, and the numbers of positive and negative decisions were 103 and 62, respectively, upon cytopathologic results. Out of the two tests, 95 cases were shown as true-positive and 3 were false positive, while 62 were true negative and 5 were false negative. Upon the results of PET-MRI test, its sensitivity, specificity, false negative rate, and false positive rate were 95.00%, 95.38%, 0.05%, and 95.15%, respectively. Therefore, it is considered to have the high potential to use the determination of the stage before the surgery, detections of recurrence and remote metastasis, assessment of uncertain remote lymph node metastasis, and so on in the diagnosis of the liver cancer, and also for the clinical utility of PET-MRI to be sufficient by integrated diagnosis and follow up scan with pathological studies.

• Radiation Oncology Journal
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• v.29 no.3
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• pp.199-205
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• 2011

Purpose: The present study compared the difference between intraoperative transrectal ultrasound (iTRUS)-based prostate volume and preplan computed tomography (CT), preplan magnetic resonance imaging (MRI)-based prostate volume to estimate the number of seeds needed for appropriate dose coverage in permanent brachytherapy for prostate cancer. Materials and Methods: Between March 2007 and March 2011, among 112 patients who underwent permanent brachytherapy with $^{125}I$, 60 image scans of 56 patients who underwent preplan CT (pCT) or preplan MRI (pMRI) within 2 months before brachytherapy were retrospectively reviewed. Twenty-four cases among 30 cases with pCT and 26 cases among 30 cases with pMRI received neoadjuvant hormone therapy (NHT). In 34 cases, NHT started after acquisition of preplan image. The median duration of NHT after preplan image acquisition was 17 and 21 days for cases with pCT and pMRI, respectively. The prostate volume calculated by different modalities was compared. And retrospective planning with iTRUS image was performed to estimate the number of $^{125}I$ seed required to obtain recommended dose distribution according to prostate volume. Results: The mean difference in prostate volume was 9.05 mL between the pCT and iTRUS and 6.84 mL between the pMRI and iTRUS. The prostate volume was roughly overestimated by 1.36 times with pCT and by 1.33 times with pMRI. For 34 cases which received NHT after image acquisition, the prostate volume was roughly overestimated by 1.45 times with pCT and by 1.37 times with pMRI. A statistically significant difference was found between preplan image-based volume and iTRUS-based volume (p<0.001). The median number of wasted seeds is approximately 13, when the pCT or pMRI volume was accepted without modification to assess the required number of seeds for brachytherapy. Conclusion: pCT-based volume and pMRI-based volume tended to overestimate prostate volume in comparison to iTRUS-based volume. To reduce wasted seeds and cost of the brachytherapy, we should take the volume discrepancy into account when we estimate the number of $^{125}I$ seeds for permanent brachytherapy.

• Investigative Magnetic Resonance Imaging
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• v.12 no.2
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• pp.161-169
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• 2008

Purpose : The aim of this study was to evaluate the usefulness of MRI performed after excisional biopsy to diagnose residual cancer and additional lesions. Materials and Methods : A total of 16 patients who had breast cancer diagnosed by excisional biopsy underwent preoperative breast MRI between March 2005 and August 2007 were included. MRI findings were considered positive for residual cancer if focal, thick, or irregular rim enhancement or adjacent enhancing lesion was identified around the postoperative biopsy cavity. And additional lesions separated from biopsy cavity including multifocal, multicentric, or contralateral lesion were evaluated. We evaluated the diagnostic accuracy of MRI, comparing MRI with histopathologic finding, and the impact of MRI on surgical planning. Results : The sensitivity and specificity of MRI for detecting residual disease considering rim enhancement were 85.7%(6/7) and 55.6%(5/9). Additional lesions including multifocal, multicentric, or contralateral lesion were found in 6 patients. In 7 patients, results of MRI findings changed surgical treatment planning. Conclusion : The pattern of rim enhancement on MRI after excisional biopsy is not differential point to evaluate remnant lesion. But MRI has an important role to help the detection of multifocal or multicentric, or contralateral breast malignancies, resulting in beneficial change in surgical treatment planning.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.2
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• pp.57-61
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• 2012

Purpose : The whole body bone scan on nuclear medicine is a widely accepted examination and procedure. However, unusual nonosseous uptake can be observed, which reflects a rare interaction between the radiopharmacceutical and the patient. This study aimed to evaluate the influence of MRI(Magnetic Resonance Imaging) contrast and $^{99m}Tc$-DPD(Dicarboxpropane diphosphonate) on whole body bone scan. Materials and Methods : We analyzed the 982 patients who were examined by $^{99m}Tc$-DPD on whole body bone scan in nuclear medicine department of pusan national university hospital from january to december 2010. All these 982 patients had MRI contrast administration prior to whole body bone scan. We analyzed laboratory test. Results : 46 patients(men 39, women 7) showed diffuse hepatic uptake on whole body bone scan. These uptakes were disappeared on the follow-up whole body bone scan. There were no significant difference of CBC test, liver function tests and renal function tests. Conclusion : The study might be an indirect evidence that diffuse hepatic and splenic uptake of 99mTc-DPD on whole body bone scan after intravenous administration of Gadolinium(Gd) MRI contrast. To perform a precise examination, Gd-contrast agent should be removed from the body before performing a whole body bone scan.

• Investigative Magnetic Resonance Imaging
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• v.18 no.1
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• pp.25-33
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• 2014

Purpose : To investigate whether quantitative parameters derived from Diffusion-weighted magnetic resonance imaging (DW-MRI) correlate with those of Dynamic contrast-enhanced MRI (DCE-MRI). Materials and Methods: Thirteen patients with pathologically or clinically proven bony metastasis who had undergone MRI prior to treatment were included. The voxel size was $1.367{\times}1.367{\times}5mm$. A dominant tumor was selected and the apparent diffusion coefficient (ADC) value and DCE-MRI parameters were obtained by matching voxels. DCE-MRI data were analyzed yielding estimates of $K^{trans}$ (volume transfer constant) and $v_e$. (extravascular extracellular volume fraction). Statistical analysis of ADC, $K^{trans}$, and $v_e$ value was conducted using Pearson correlation analyses. Results: Fifteen lesions in pelvic bones were evaluated. Of these, 11 showed a statistically significant correlation (P<0.05) between ADC and $K^{trans}$. The ADC and $K^{trans}$ were inversely related in 7 lesions and positively related in 4 lesions. This did not depend on the primary cancer or site of metastasis. The ADC and $v_e$ of 9 lesions correlated significantly. Of these, 4 lesions were inversely related and 5 lesions were positively related. Conclusion: Unlike our theoretic hypothesis, there was no consistent correlation between ADC values and $K^{trans}$ or between ADC values and $v_e$ in metastatic bone tumors.