• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.15-20
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• 2017

Objective : Diagnosing tumor progression and pseudoprogression remains challenging for many clinicians. Accurate recognition of these findings remains paramount given necessity of prompt treatment. However, no consensus has been reached on the optimal technique to discriminate tumor progression. We sought to investigate the role of magnetic resonance perfusion (MRP) to evaluate tumor progression in glioma patients. Methods : An institutional retrospective review of glioma patients undergoing MRP with concurrent clinical follow up visit was performed. MRP was evaluated in its ability to predict tumor progression, defined clinically or radiographically, at concurrent clinical visit and at follow up visit. The data was then analyzed based on glioma grade and subtype. Resusts : A total of 337 scans and associated clinical visits were reviewed from 64 patients. Sensitivity, specificity, positive and negative predictive value were reported for each tumor subtype and grade. The sensitivity and specificity for high-grade glioma were 60.8% and 87.8% respectively, compared to low-grade glioma which were 85.7% and 89.0% respectively. The value of MRP to assess future tumor progression within 90 days was 46.9% (sensitivity) and 85.0% (specificity). Conclusion : Based on our retrospective review, we concluded that adjunct imaging modalities such as MRP are necessary to help diagnose clinical disease progression. However, there is no clear role for stand-alone surveillance MRP imaging in glioma patients especially to predict future tumor progression. It is best used as an adjunctive measure in patients in whom progression is suspected either clinically or radiographically.

• Journal of the Korean Magnetics Society
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• v.6 no.4
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• pp.272-276
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• 1996

1948년 Harvard 대학의 Purcell교수와 Stanford 대학의 Bloch교수가 핵자기 공명(Nuclear Magnetic Resonance : NMR) 현상을 발견한 이래로 NMR은 물질의 분자단위에서 화학적, 물리학적 성질을 밝혀내는 탁월한 방법으로 널리 이용되어 왔다. NMR 현상을 이용한 영상촬영법(Magnetic Resonance Imaging, MRI)은 1970년대초 Lauterber와 Damadian 교수가 처음 영상을 얻을 수 있다는 가능성을 제시한 이후 급속한 발전을 하여 1980년대 초에는 Moore와 Holland에 의해 의학분야에 응용 가능할 정도의 영상이 얻어졌다. 1980년대 중반부터 상용화 되었으며 최근 그 기법도 NMR현상과 연관된 파라미터인 $T_{1}$, $T_{2}$는 물론 혈류의 속도, 자화율, 확산(Diffusion), Perfusion의 영상기법을 비롯해 혈관조영술(MR Angiography), 뇌기능영상(Functional Imaging)등 과거에는 상상도 할 수 없었던 다양한 영상기법 개발되었다. 여기서는 먼저 MRI의 원리를 설명한 후 MRI의 여러 촬영기법들과 그 응용에 관해 설명하겠다.

• Korean Journal of Radiology
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• v.22 no.11
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• pp.1809-1821
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• 2021

Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called "dark-dark appearance") and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.3
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• pp.159-164
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• 2009

Coronary artery disease is on the rise over the world. Myocardial perfusion SPECT is a well established technique to detect coronary artery disease and to assess left ventricular function. In addition, it has the unique ability to predict the prognosis of the patients. Moreover, the application of ECC-gated images provided the quantitatve data and improved the accuracy. This approach has been proved to be cost-effective and suitable for the emerging economies as well as developed countries. However, the utilization of nuclear cardiology procedures vary widely considering the different countries and region of the world. Korea exits 2-3 times less utilization than Japan, and 20 times than the United States. Recently, with the emerging of new technology, namely cardiac CT, cardiac MR and stress echocardiography, the clinical usefulness of nuclear cardiology has been called in question and its role has been redefined. For the proper promotion of nuclear cardiology, special educations should be conducted since the nuclear cardiology has the contact points between nuclear medicine and cardiology. Several innovations are in horizon which will impact the diagnostic accuracy as well as imaging time and cost savings. Development of new tracers, gamma camera technology and hybrid systems will open the new avenue in cardiac imaging. The future of nuclear cardiology based on molecular imaging is very exciting. The newly defined biologic targets involving atherosclerosis and vascular vulnerability will allow the answers for the key clinical questions. Hybrid techniques including SPECT/CT indicate the direction in which clinical nuclear cardiology may be headed in the immediate future. To what extent nuclear cardiology will be passively absorbed by other modalities, or will actively incorporate other modalities, is up to the present and next generation of nuclear cardiologists.

• Investigative Magnetic Resonance Imaging
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• v.6 no.2
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• pp.158-165
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• 2002

Purpose : To evaluate the effect of Gd-DTPA on signal intensity of diffusion-weighted magnetic resonance(MR) image and apparent diffuse coefficient (ADC) in dog brain with hype racute stroke. Materials and methods : Experimental canine model of hyperacute cerebral infarction was made by selective intraarterial embolization with particulate embolic material. Diffusion-weighted MR imaging was performed in five dogs at 1 hour after the embolization of internal carotid artery. After intravenous bolus injection of Gd- DTPA, additional 11 diffusion-weighted MR images were serially obtained from 2 minutes to 90 minutes after injection in each dog. The author evaluated findings of hyperacute cerebral infarction on diffusion-weighted MR imaging, and calculated mean signal intensity and mean ADC in infarcted region and contralateral normal region. Statistical analysis of mean signal intensity, mean ADC and contrast-noise ratio before and after Gd-DTPA injection was performed. Results : Hyperacute cerebral infarction developed in all five dogs on diffusion-weighted MR images obtained 1 hour after embolization. The area of hyperacute infarction had steady increase in signal intensity on diffusion-weighted MR image and decrease in ADC. In normal perfusion area, decrease in signal intensity was observed at 2 minutes the Gd-DTPA injection, whereas ADC did not changed. Conclusion : Intravenous injection of Gd-DTPA had no influence on ADC in both hyperacute infarction and normally perfused are a, but caused initial transient signal reduction in normally perfused area on diffusion-weighted MR image due to susceptibility effect of Gd-DTPA. It is important to calculate ADC in evaluating the effect of diffusion after injection of Gd-DTPA.

• Proceedings of the KOSOMBE Conference
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• v.1998 no.11
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• pp.281-282
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• 1998

Recently, there has been growing interest in the assessment of physiological parameters on brain perfusion that provide more information than pure morphologic diagnosis. Quantification of parameters that characterize cerebral micro-circulation with magnetic resonance imaging is of great relevance for clinical application. We determine the local tissue concentration by exponential relationship between the relative signal reduction S(t)/$S_0$ and local tissue concentration of contrast material $C_m(t)$ in dynamic susceptibility contrast enhanced MR imaging. And then we made relative regional blood volume map by calculating the area under the measured concentration-time curves $C_m(t)$ during first pass of paramagnetic contrast material as a preliminary step for perfusion map. These images make it possible to compare the rCBV in different brain regions in one individual at a time. We have it in contemplation to obtain arterial and brain signal time curves simultaneously to make absolute rCBV and perfusion (rCBF) map. These maps may provide the method of comparative investigations of different patients having strong variation in AIF.

• Journal of Biomedical Engineering Research
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• v.16 no.2
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• pp.209-216
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• 1995

Recently, a new tailored RF gradient echo (TRFGE) sequence was reported. This technique not only enhances the magnetic susceptibility effect but also allows us to measure local changes in brain oxygenation. In this study, a phantom and cat brain experiments were performed on a 4.7 Tesla BIQSPEC (BRUKER) instrument with a 26 cm gradient system. We have demonstrated that the signal intensity (SI) of the TRFGE sequence varies according to the concentration of susceptibility contrast agent. Three capillary tubes with different concentrations of Gd-DTPA (0.01, 0.05, 0.1 mMOI/l) were placed at the middle of a cylindrical water phantom. Using both TRFGE and conventional gradient echo (CGE) sequences, phantom images of the slices which contain all three tubes were obtained. For the animal experiment, cats were anesthetized and ventilated using halotane (0.5%) and a $N_2O/ O_2$ mixture (2:1), and blood pressure and heart rate were monitored and kept normal. For the observation of tue first pass of Gd- DTPA, imaging was started at t = 0. At t = 8 ~ 12s, 0.2 mMol/Kg Gd-DTPA was manually injected in the femoral vein. The imaging parameters were TRITE = 25/10 msec, flip angle = $30^{\circ}$, FOV = 10cm, image matrix size = $128{\times}128$ with 64 phase encodings and the image data acquisition window was 10 msec. SI-time curves were then obtained from a series of 30 images which were collected at 2 sec intervals using both CGE and TRFGE pulse sequences before, during, and following the contrast injection.

• Investigative Magnetic Resonance Imaging
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• v.4 no.2
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• pp.113-119
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• 2000

Purpose : To know the possibility of clinical application of MRI using oxygen inhalation as a perfusion MRI Materials and methods : Two healthy volunteers and three patients of one moyamoya disease, one acute infarction and one meningioma were studied using a 1.5 Tesla MRI unit. Oxygen (15 liters/min) mixed with room air was given using face mask from 8 second to 35 second during the study. Images were acquired 25 times (scan time per study were 1.6 seconds) using susceptibility contrast EPI (echo planar image) sequence. Difference maps were acquired by early (study 12-18), and late (study 19-25) O2 inhalation image groups minus pre-O2 inhalation image group (study 3-9) with a Z-score of 0.7-1.0 using VB31C program of Magneton Vision. The resulting perfusion images were created by superimposition of difference maps on corresponding T1 weighted anatomic images. On moyamoya patient, similar perfusion images were acquired after Gd-DTPA injection, and compared with O2 inhalation perfusion images. Results ; The author can get the perfusion images of the brain by oxygen inhalation with susceptibility contrast EPI sequence at the volunteers, and the patient of moyomoya disease, acute infarction and meningioma. On moyamoya patient, perfusion images with O2 inhalation are similar with perfusion images by Gd-DTPA injection. Conclusion 1 This study has demonstrated that the susceptibility contrast EPI by oxygen inhalation can be used as the clinically useful perfusion MRI technique

• Journal of the Korean Magnetic Resonance Society
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• v.9 no.2
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• pp.93-102
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• 2005

Purpose: To develop an advanced non-linear curve fitting (NLCF) algorithm for dynamic susceptibility contrast study of brain. Materials and Methods: The first pass effects give rise to spuriously high estimates of $K^{trans}$ in voxels with large vascular components. An explicit threshold value has been used to reject voxels. Results: By using this non-linear curve fitting algorithm, the blood perfusion and the volume estimation were accurately evaluated in T2*-weighted dynamic contrast enhanced (DCE)-MR images. From the recalculated each parameters, perfusion weighted image were outlined by using modified non-linear curve fitting algorithm. This results were improved estimation of T2*-weighted dynamic series. Conclusion: The present study demonstrated an improvement of an estimation of kinetic parameters from dynamic contrast-enhanced (DCE) T2*-weighted magnetic resonance imaging data, using contrast agents. The advanced kinetic models include the relation of volume transfer constant $K^{trans}\;(min^{-1})$ and the volume of extravascular extracellular space (EES) per unit volume of tissue $\nu_e$.

• Investigative Magnetic Resonance Imaging
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• v.4 no.2
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• pp.100-106
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• 2000

Purpose : To evaluate the usefulness of cerebral blood flow measurement applied to perfusion weighted image with short-scan time single shot gradient echo-planar technique in measuring cerebral blood volume(rCBV) of normal rabbits. Materials and methods : With 2.1-3.6 kg weighted rabbits, image is acquired when they are in supine position in children positioner. Perfusion weighted image is acquired to 44 seconds per 1 second successively. After 4 seconds later, Gd-DTPA 2ml are injected into int. jugular vein with 2 ml per second and normal saline is also injected after that. Same technique is applied 2 times per 30 minites in same rabbit. After Image is obtained in two part of cerebral cortex at vertex, convexity, in one of basal ganglia with choosing about $3-5{\textrm{mm}^2}$ areas. Curve of signal intensity changes in time sequence is drawn. After this images are transmitted by PC and software IDL, regional cerebral blood volume is measured with imaging processing program made by us. Results : With 22 of 24 rabbits, satisfactory 1-2 signal intensity versus time curve is made. Cerebral blood capacity and contrast media stay time (ST) is measured in two cerebral cortex and basal ganglia refering in parietal cerebral cortex. Mean focal cerebral blood flow capacity ratio in cortex was $0.97{\pm}0.35$ and in basal ganglia, $0.99{\pm}0.37$, mean contrast media stay time in cortex was $9.83{\pm}1.63$ sec and in basal gaiglia, $9.42{\pm}1.14$ sec, but there was no statistically significant difference between two areas ($\rho$=0.05). Conclusion : In cerebral cortex and basal ganglia, there is no difference in mean focal blood volume and mean contrast stay time. Therefore, PWI is useful in cerebral blood flow and early diagnosis, prognosis of cerebral ischemic disease. Hereafter, it is helpful in analysing cerebral blood flow changes with comparison difference in rCBV between normal tissue and ischemic tissue, and that with DWI finding in infarcted patient.