• Investigative Magnetic Resonance Imaging
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• v.26 no.2
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• pp.135-149
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• 2022

Purpose: To assess clinically significant imaging findings of malignant intramammary lymph nodes (IMLNs) in breast cancer patients and to evaluate their diagnostic performance in predicting malignant IMLN. Materials and Methods: A total of 110 cases with IMLN of BI-RADS category 3 or more, not typical benign IMLN, in MR of breast cancer patients between January 2016 and January 2021 were retrospectively reviewed. After excluding 33 cases, 77 cases were finally included. Among them, 58 and 19 were confirmed as benign and malignant, respectively. Qualitative and quantitative MR imaging features of the IMLN were retrospectively analyzed. Sizes and final assessment categories of IMLN on MRI, mammography, and ultrasound were reviewed. Diagnostic performances of imaging features on MRI, mammography, and ultrasound were then evaluated. Results: For qualitative MR features, shape, margin, and preserved central hilum were significantly different between benign and malignant groups (P < 0.05). For quantitative MR features, long diameter over 6 mm, short diameter over 4 mm, and cortical thickening over 3 mm showed high sensitivities in predicting malignant IMLNs (89.5%, 94.7%, and 100%, respectively). Size exceeding 1 cm showed high specificity and accuracy in predicting malignant IMLN on MR, mammography, and ultrasound (91.4% and 80.5%; 96.6% and 79.25; 98.3% and 80.5%, respectively). Conclusion: Various MR imaging features and size can be helpful for predicting malignant IMLN in breast cancer patients.

• Investigative Magnetic Resonance Imaging
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• v.21 no.3
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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.

• Investigative Magnetic Resonance Imaging
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• v.21 no.4
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• pp.233-241
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• 2017

Purpose: To report on the current practices in breast magnetic resonance imaging (MRI) in Korea. Materials and Methods: We invited the 68 members of the Korean Society of Breast Imaging who were working in hospitals with available breast MRI to participate in a survey on how they performed and interpreted breast MRI. We asked one member from each hospital to respond to the survey. A total of 22 surveys from 22 hospitals were analyzed. Results: Out of 22 hospitals, 13 (59.1%) performed at least 300 breast MRI examinations per year, and 5 out of 22 (22.7%) performed > 1200 per year. Out of 31 machines, 14 (45.2%) machines were 1.5-T scanners and 17 (54.8%) were 3.0-T scanners. All hospitals did contrast-enhanced breast MRI. Full-time breast radiologists supervised the performance and interpreted breast MRI in 19 of 22 (86.4%) of hospitals. All hospitals used BI-RADS for MRI interpretation. For computer-aided detection (CAD), 13 (59.1%) hospitals sometimes or always use it and 9 (40.9%) hospitals did not use CAD. Two (9.1%) and twelve (54.5%) hospitals never and rarely interpreted breast MRI without correlating the mammography or ultrasound, respectively. The majority of respondents rarely (13/21, 61.9%) or never (5/21, 23.8%) interpreted breast MRI performed at an outside facility. Of the hospitals performing contrast-enhanced examinations, 15 of 22 (68.2%) did not perform MRI-guided interventional procedures. Conclusion: Breast MRI is extensively performed in Korea. The indication and practical patterns are diverse. The information from this survey would provide the basis for the development of Korean breast MRI practice guidelines.

• Journal of Yeungnam Medical Science
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• v.4 no.1
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• pp.1-15
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• 1987

Magnetic Resonance (M.R.) is rapidly emerging technique that provides high quality images and potentially provides much more diagnostic information than do conventional imaging modalities. M.R.I. is conceptually quite different from currently used imaging methods. The complex nature of M.R.I. allows a great deal of flexibility in image product ion and available information, and key points are as follows. 1. M.R.I. offers a non-invasive technique with which to gene rate in vivo human images without ionizing radiation and with no known adverse biological effects. 2. Imaging mechanism of M.R.I. is quite different from conventional imaging modality and for more accurate diagnostic application, It is necessary for physician to understand imaging mechanism of M.R.I. 3. M.R. makes available basic chemical parameters that may provide to be useful for diagnostic medical imaging and more specific pathophysiologic information which are not available by alternate techniques. 4. M.R. can be produced by number of different methods. This flexibility allows the imaging technique to be applicated for particular clinical purpose. Multiplanar and three dimensional imaging may extend the imaging process beyond the single section available with current CT. 5. Future directions include efforts to; a. Further development of hard ware b. More fasternning scan time c. Respiratory and cardiac gated imaging d. Imaging of additional nuclei except hydrogen e. Further development of contrast media f. M.R. in vivo spectroscopy g. Real time M.R. imaging.

• Investigative Magnetic Resonance Imaging
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• v.13 no.1
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• pp.9-14
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• 2009

T1-, and T2-weighted imagings and FLAIR (fluid attenuated inversion recovery) imaging are fundamental imaging methods in the brain. T1-weighted imaging is a spin-echo sequence with short TR and short TE and produces the tissue contrast by different T1 relaxation times. In other words, short TR maximizes the difference of the longituidinal magnetization recovery between the tissues. T2-weighted imaging is a spin-echo sequence with long TR and long TE and produces the tissue contrast by different T2 relaxation times. Long TE maximizes the difference of the transverse magnetization decay between the tissues. FLAIR is an inversion recovery sequence using 180 degree inversion pulse. 2500 msec of inversion time is applied to suppress the CSF signal.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.123-132
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• 2013

Purpose : We report the results of the various parameters of diffusion tensor imaging (DTI) and CSF flow study of the cervical spinal cord using magnetic resonance (MR) imaging techniques. Materials and Methods: Intramedullary FA and MD were measured in the gray matter and posterior cord of the white matter and both lateral cords of the white matter at the C2-3, C4-5, C5-6 spinal levels. For the CSF flow study, velocity encoding was obtained at the C2-3, C4-5, C5-6 spinal levels. Results: There was a significant difference of the FA and MD between the white matter and gray matter (p < 0.05). The FA of the gray matter was significantly different according to the cervical spinal cord levels (p < 0.05). Otherwise, the FA and MD parameters were not significantly different (p > 0.05). The mean peak systolic velocity and mean peak diastolic velocity were $5.18{\pm}2.00cm/sec$ and $-7.32{\pm}3.18cm/sec$, respectively from C2 to C6 spinal cords. There was no significant difference in these velocities among the cervical spinal cord (p > 0.05). Conclusion: This basic information about DTI and CSF dynamics of the cervical spinal cord may be useful for assessing cervical spinal cord abnormalities using MR imaging.

• Korean Journal of Radiology
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• v.20 no.1
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• pp.83-93
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• 2019

Objective: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77-0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = -0.61, p < 0.001) and changes in EF (β = -0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17-0.85; p = 0.019). Conclusion: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.

• Investigative Magnetic Resonance Imaging
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• v.4 no.1
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• pp.14-19
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• 2000

Purpose : This study was to present the functional brain mapping of both functional magnetic resonance imaging(MRI) and transcranial magnetic stimulation(TMS) in a case of schizencephaly. Materials and methods : A 28-year-old man, who had left hemiplegia and schizencephaly in right cerebral hemisphere, was exacted with both functional MRI and TMS. Motor function of left hand was decreased whereas right hand was within normal limit. For functional MRI, gradient-echo echo planar imaging($TR/TE/{\alpha}$=1.2 sec/90 msec/90) was employed. The paradigm of motor task consisted of repetitive self-paseo hand flexion-extension exercises with 1-2 Hz periods. An image set of 10 slices was repetitively acquired with 15 seconds alternating periods of task performance and rest and total 6 cycles (three ON periods and three OFF periods) were performed. In brain mapping, TMS was performed with the round magnetic stimulator (mean diameter; 90mm). The magnetic stimulation was done with 80% of maximal output. The latency and amplitude of motor evoked potential(MEP)s were obtained from both abductor pollicis brevis(APB) muscles. Results : Functional MRI revealed activation of the left primary motor cortex with flexion-extension exercises of healthy right hand. On the other hand, the left primary motor cortex, left supplementary motor cortex, and left promoter areas were activated with flexion-extension exercises of left hand. In TMS, magnetic evoked potentials were induced in no areas of right cerebral hemisphere, but in 5 areas of left corebral hemisphere from both abductor pollicis brevis. Latency, amplitude, and contour of response of the magnetic evoked potentials in both hands were similar. Conclusion : Functional MRI and TMS in a patient with schizencephaly were successfully used to localize cortical motor function. Ipsilateral motor pathway is thought to be secondary to reinforcement of the corticospinal tract of the ipsilateral motor cortex.

• Investigative Magnetic Resonance Imaging
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• v.24 no.1
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• pp.21-29
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• 2020

Purpose: To investigate normal location of the peroneus longus tendon (PL) in the cuboid groove by evaluating it between ankles with no significant abnormality (asymptomatic group) and those with retromalleolar PL dislocation (dislocation group) using three-dimensional isotropic fast spin-echo (3D-FSE) magnetic resonance imaging (MRI) of the ankle. Materials and Methods: Thirty-six and 32 3D-FSE ankle MRI were assigned to the asymptomatic group and the dislocation group, respectively. Using multiplanar reformatted 3D-FSE, qualitative PL location (i.e., outside, overlying, and inside in relation to the cuboid groove), quantitative PL location (i.e., distance between the proximal margins of PL and cuboid groove), and cuboid groove size were measured in lateral, middle, and medial levels of the cuboid groove. Results: In the asymptomatic group, 64%, 42%, and 11%, respectively, had the outside or overlying-located PL in lateral, middle, and medial levels of the cuboid groove and the quantitative location gradually decreased from lateral to medial level. Qualitative and quantitative PL locations were not significantly different between the asymptomatic group and dislocation group. Cuboid groove size showed significant negative correlation with quantitative PL location in both groups. Conclusion: Outside- or overlying-located PL in lateral and middle levels of the cuboid groove would be a normal finding, regardless of PL status at the retromalleolar level.

• Investigative Magnetic Resonance Imaging
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• v.24 no.1
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• pp.30-37
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• 2020

Purpose: Preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population. It is controversial whether diffuse excessive high signal intensity (DEHSI) represents damage to the white matter or delayed myelination in preterm infants. This study investigated MRI findings for predicting the severity of neurodevelopmental outcomes and assessing whether preterm infants with DEHSI near term-equivalent age have abnormal neurodevelopmental outcomes. Materials and Methods: Preterm infants (n = 64, gestational age at birth < 35 weeks) undergoing brain MRI near term-equivalent age and subsequent neurodevelopmental outcomes were evaluated between 18 and 24 months of age. The associations of MRI findings and the risk of severe cognitive delay, severe psychomotor delay, cerebral palsy (CP), and neurosensory impairment were analyzed. The associations of DEHSI with risks of severe cognitive delay, severe psychomotor delay, CP, and neurosensory impairment (hearing or visual impairment) were analyzed. Outcome data were evaluated by logistic regression and the Fisher's exact test. Results: There were significant associations between abnormal white matter findings and delayed mental development, delayed psychomotor development, neurosensory impairment, and presence of CP. The presence of DEHSI was not correlated with delayed neurodevelopmental outcomes or presence of CP. In multivariate logistic regression analyses, cystic encephalomalacia, punctate lesion, loss of white matter volume and ventricular dilation were significantly associated with CP. Conclusion: Abnormal MRI findings near term-equivalent age in preterm infants predict adverse neurodevelopmental outcomes. No significant association between DEHSI and adverse neurodevelopmental outcomes was demonstrated.