• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.336-344
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• 2000

Objective : The treatment for prolactin secreting pituitary adenoma(prolactinoma) include pharmacology, surgery, radiation therapy or radiosurgery. The recent development of radiological imaging and microsurgery has made transsphenoidal microsurgery the treatment of choice for most prolactin secreting pituitary adenoma. Despite its low morbidity and mortality, relatively high recurrence and failure rate have been reported. Recent advances in neuroimaging provide a precise targeting in radiosurgery for treatment of prolactin secreting pituitary adenoma. In this regard, Gamma knife radiosurgery has been proposed as an alternative primary treatment modality or adjuvant therapy. Patients and Methods : Twenty three patients with prolactin secreting pituitary adenoma have been treated with Gamma knife radiosurgery in our institute from March 1992 to September 1998. We analyzed clinical, radiological and endocrinological changes in 21 patients who were followed up for an average of 35.7 months. Results : The mean age was 34.9 years and 16 patients were treated with Gamma knife radiosurgery as primary treatment and 5 patients underwent Gamma knife radiosurgery for residual tumors after microsurgery. The margin of the tumor was incorporated within the 40 to 80% and the mean marginal dose was 24.5 Gy. Clinical improvement in the last follow-up were present in 17 cases(81.0%) and 3 of 5 infertility patients became pregnant after Gamma knife radiosurgery. Tumor control rate after Gamma knife radiosurgery was 100%. Endocrinological normalization in the last follow-up were obtained in 12 cases(57.1%). In three cases, hormonal normalizations were present in early period(3-32 months) but serum hormone levels were elevated subsequently. Conclusion : We conclude that the Gamma knife radiosurgery for prolactin secreting pituitary adenoma seems to be safe and effective as adjuvant therapy after microsurgery and primary treatment modality in selective patients.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.1-7
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• 2017

Objective : The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. Methods : We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. Results : The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were $2.21{\pm}24.57mmH_2O$. The frequency of CSF lumbar tapping was $2.06{\pm}1.26times$. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was $-3.69{\pm}19.20mmH_2O$. The mean frequency of CSF lumbar tapping was $2.07{\pm}1.25times$. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was $38.07{\pm}23.58mmH_2O$. The mean frequency of CSF lumbar tapping was $1.44{\pm}1.01times$. Pressure difference greater than $35mmH_2O$ was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant (p=0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. Conclusion : Under-drainage of CSF should be suspected if CSF lumbar tapping pressure is $35mmH_2O$ higher than the valve opening pressure and shunt malfunction evaluation or adjustment of the valve opening pressure should be made.

• 대한안과학회지
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• 제59권11호
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• pp.1087-1090
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• 2018

목적: 중뇌(midbrain) 등쪽(dorsal)의 사구수조지방종(quadrigeminal cistern lipoma)에 의한 도르래신경마비를 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 남자가 2년 전부터 간헐 양안 수직 복시가 있었으나 별다른 치료 없이 지내다가 2주 전부터 항상 증상이 생겨 내원하였다. 1달 전 진단받은 당뇨 이외에 다른 전신질환의 과거력은 없었다. 시력은 우안 20/25, 좌안 20/20이었고, 상대구심동공운동장애는 없었다. 안구운동검사에서 원거리 주시에서 4프리즘디옵터(prism diopters, PD)의 좌안 상사시와 근거리에서 4PD의 외사시를 보였다. 좌안은 내전시상전(elevation in adduction)이 있었다. 머리기울임검사에서 좌측 기울임에서 6PD의 좌안 상사시가 보였고, 우측 기울임에서는 정위를 보였다. 안저검사에서 우안 외회선과 좌안 내회선이 보였다. 뇌자기공명영상(brain magnetic resonance imaging)에서 중뇌 등쪽에서 나오는 도르래신경에 인접한 사구수조지방종을 확인하였다. 복시 증상의 완화를 위해 프리즘 안경을 처방하였고, 다른 신경 증상을 동반하지 않아 뇌 병변에 대한 경과관찰을 시행하기로 하였다. 결론: 중뇌 등쪽의 사구수조지방종으로 인해 도르래신경마비를 확인하였다. 종양의 압박에 의한 도르래신경마비는 드물지만, 본 증례와 같이 비특이적인 증상을 보인 도르래신경마비 환자에서는 빠른 뇌영상검사가 원인 감별에 도움을 줄 수 있다.

• 정신신체의학
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• 제23권1호
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• pp.66-69
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• 2015

정상뇌압수두증은 보행장애, 요실금 및 치매 등의 전형적인 세 가지 증상 외에도 추체외로 증상과 다양한 신경심리 증상이 동반될 수 있다. 이 사례는 불안과 정동증상으로 치료 중 보행장애와 요실금 증상을 보였던 46세 여자 환자에서 항파킨슨 약물의 사용과 기존 정신과 치료 약물의 중단에도 불구하고 증상의 호전이 없었으나, 뇌 컴퓨터 단층 촬영상 뇌실의 확장 소견이 보였고 시험적 뇌척수액 배액에 의해서 수일 내에 증상들이 극적으로 호전되어 정상뇌압수두증을 감별해야 했던 경우이다. 뚜렷한 대뇌 실질의 위축 소견이 없으나 뇌실이 확장되어 있을 경우 추체외로 증상과 신경심리 증상이 있을 경우 정상뇌압수두증의 전형적 세 가지 증상을 보이지 않는다 하더라도 정상뇌압수두증의 가능성을 고려해서 시험적 뇌척수액 배액 등의 시술이 진단과 치료에 도움이 될 수 있음을 보여주는 사례라고 생각된다.

• 인지과학
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• 제29권3호
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• pp.161-192
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• 2018

부호화된 사건의 시간적 정보를 기반으로 한 인출은 일화기억의 중요한 통제기제 중 하나이다. 기억인출과 관련한 수많은 신경영상 연구들이 진행되었음에도 아직 시간적으로 구성된 일화기억의 인출에 관여하는 뇌신경연결망 패턴에 대해서는 알려진 바가 많지 않다. 본 연구에서는 두가지 다른 순차적 인출 뇌신경 기제를 구분하기 위하여 과제기반 기능적 연결성 다변량 패턴분석 방법을 사용하였다. 참가자들은 시간적 일화기억과제를 수행하였고, 순서대로 부호화된 기억자극을 순방향 혹은 역방향으로 인출하도록 지시를 받았다. 부분적으로 분류된 국소적 신경네트워크 패턴은 두 인출기제를 잘 구분하지 못한 반면, 기억과 관련된 인지통제 영역과 목표-지향적 인지기제처리에 관련된 것으로 알려진 여러 피질-피질하 노드들을 아우르는 전뇌신경네트워크 패턴은 시간적 일화기억 인출기제를 잘 구분하였다. 이 영역들은 측면/내측 전전두엽 영역, 하부 두정엽, 중간 측두회, 선조체 영역 등을 포함하며 기계학습을 이용한 분류에서 높은 분류 예측률을 보였다. 본 연구의 결과는 일화기억의 시간적 인출기제에 관여하는 피질-피질하 여러 영역의 관여를 확인하였고, 대역적 네트워크 패턴의 기능적 연결성이 질적으로 다른 인출기제에 관여함을 확인하였다는데에 중요성을 갖는다.

• The Korean Journal of Pain
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• 제36권1호
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• pp.113-127
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• 2023

Background: Resting-state functional connectivity (rs-FC) may aid in understanding the link between painmodulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life. Methods: This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group. Results: Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63-0.94) to discriminate who does/does not respond to the CPM-test. Conclusions: These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.

• Korean Journal of Radiology
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• 제22권1호
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• pp.118-130
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• 2021

Objective: This study aimed to investigate the blood-brain barrier (BBB) disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS) using dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and automatic whole brain segmentation. Materials and Methods: Forty-two consecutive mTBI patients with PCS who had undergone post-traumatic MR imaging, including DCE MR imaging, between October 2016 and April 2018, and 29 controls with DCE MR imaging were included in this retrospective study. After performing three-dimensional T1-based brain segmentation with FreeSurfer software (Laboratory for Computational Neuroimaging), the mean K^trans and v_p from DCE MR imaging (derived using the Patlak model and extended Tofts and Kermode model) were analyzed in the bilateral cerebral/cerebellar cortex, bilateral cerebral/cerebellar white matter (WM), and brainstem. K^trans values of the mTBI patients and controls were calculated using both models to identify the model that better reflected the increased permeability owing to mTBI (tendency toward higher K^trans values in mTBI patients than in controls). The Mann-Whitney U test and Spearman rank correlation test were performed to compare the mean K^trans and v_p between the two groups and correlate K^trans and v_p with neuropsychological tests for mTBI patients. Results: Increased permeability owing to mTBI was observed in the Patlak model but not in the extended Tofts and Kermode model. In the Patlak model, the mean K^trans in the bilateral cerebral cortex was significantly higher in mTBI patients than in controls (p = 0.042). The mean v_p values in the bilateral cerebellar WM and brainstem were significantly lower in mTBI patients than in controls (p = 0.009 and p = 0.011, respectively). The mean K^trans of the bilateral cerebral cortex was significantly higher in patients with atypical performance in the auditory continuous performance test (commission errors) than in average or good performers (p = 0.041). Conclusion: BBB disruption, as reflected by the increased K^trans and decreased v_p values from the Patlak model, was observed throughout the bilateral cerebral cortex, bilateral cerebellar WM, and brainstem in mTBI patients with PCS.

• Korean Journal of Radiology
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• 제23권10호
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• pp.959-975
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• 2022

Objective: To investigate the agreement and reliability of estimating the volumes and normative percentiles (N%) of segmented brain regions among NeuroQuant (NQ), DeepBrain (DB), and FreeSurfer (FS) software programs, focusing on the comparison between NQ and DB. Materials and Methods: Three-dimensional T1-weighted images of 145 participants (48 healthy participants, 50 patients with mild cognitive impairment, and 47 patients with Alzheimer's disease) from a single medical center (SMC) dataset and 130 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset were included in this retrospective study. All images were analyzed with DB, NQ, and FS software to obtain volume estimates and N% of various segmented brain regions. We used Bland-Altman analysis, repeated measures ANOVA, reproducibility coefficient, effect size, and intraclass correlation coefficient (ICC) to evaluate inter-method agreement and reliability. Results: Among the three software programs, the Bland-Altman plot showed a substantial bias, the ICC showed a broad range of reliability (0.004-0.97), and repeated-measures ANOVA revealed significant mean volume differences in all brain regions. Similarly, the volume differences of the three software programs had large effect sizes in most regions (0.73-5.51). The effect size was largest in the pallidum in both datasets and smallest in the thalamus and cerebral white matter in the SMC and ADNI datasets, respectively. N% of NQ and DB showed an unacceptably broad Bland-Altman limit of agreement in all brain regions and a very wide range of ICC values (-0.142-0.844) in most brain regions. Conclusion: NQ and DB showed significant differences in the measured volume and N%, with limited agreement and reliability for most brain regions. Therefore, users should be aware of the lack of interchangeability between these software programs when they are applied in clinical practice.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1345-1354
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• 2020

Objective: To evaluate radiomics analysis in studies on mild cognitive impairment (MCI) and Alzheimer's disease (AD) using a radiomics quality score (RQS) system to establish a roadmap for further improvement in clinical use. Materials and Methods: PubMed MEDLINE and EMBASE were searched using the terms 'cognitive impairment' or 'Alzheimer' or 'dementia' and 'radiomic' or 'texture' or 'radiogenomic' for articles published until March 2020. From 258 articles, 26 relevant original research articles were selected. Two neuroradiologists assessed the quality of the methodology according to the RQS. Adherence rates for the following six key domains were evaluated: image protocol and reproducibility, feature reduction and validation, biologic/clinical utility, performance index, high level of evidence, and open science. Results: The hippocampus was the most frequently analyzed (46.2%) anatomical structure. Of the 26 studies, 16 (61.5%) used an open source database (14 from Alzheimer's Disease Neuroimaging Initiative and 2 from Open Access Series of Imaging Studies). The mean RQS was 3.6 out of 36 (9.9%), and the basic adherence rate was 27.6%. Only one study (3.8%) performed external validation. The adherence rate was relatively high for reporting the imaging protocol (96.2%), multiple segmentation (76.9%), discrimination statistics (69.2%), and open science and data (65.4%) but low for conducting test-retest analysis (7.7%) and biologic correlation (3.8%). None of the studies stated potential clinical utility, conducted a phantom study, performed cut-off analysis or calibration statistics, was a prospective study, or conducted cost-effectiveness analysis, resulting in a low level of evidence. Conclusion: The quality of radiomics reporting in MCI and AD studies is suboptimal. Validation is necessary using external dataset, and improvements need to be made to feature reproducibility, feature selection, clinical utility, model performance index, and pursuits of a higher level of evidence.

• 대한영상의학회지
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• 제85권3호
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• pp.607-617
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• 2024

목적 최근 확산강조 자기공명신경조영(diffusion-weighted MR neurography; 이하 DW MRN)이 신경근 평가에 도움이 된다고 보고되었다. 본 연구는 1.5T MR에서 단일방향 경사자장을 사용한 DW MRN의 요추 신경근 평가의 유용성을 확인하고자 한다. 대상과 방법 앞뒤 방향 경사자장의 DW MRN을 포함한 64요추 MR을 후향적으로 분석했다. 제3 요추에서 제1 천추까지 총 512개 요추 신경근의 변화를 T2 강조영상, 조영증강 T1 강조영상, 그리고 DW MRN에서 평가하고 일치도와 상관관계 분석을 했다. 결과 T2 강조영상에서 78개의 신경근 압박이 있었고, 조영증강 T1 강조영상에서 52개 신경근이 조영증강되었다. DW MRN에서 67개 신경근의 부종과 고신호강도가 있었다. 조영증강 T1 강조영상과 DW MRN 모두 신경근의 변화가 나타난 경우는 42개였다. DW MRN과 조영증강 T1 강조영상, T2 강조영상 간에 중간 또는 상당한 일치도와 양의 상관관계를 보였다(κ = 0.59-0.65, ρ = 0.600-0.653). 결론 앞뒤 단일방향을 사용한 DW MRN은 척추 신경근의 변화 평가에 도움이 되며, 가돌리늄 조영증강을 대체 또는 보완하는 역할을 할 수 있을 것이다.