• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.261-264
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• 2014

We report perfusion weighted imaging (PWI) findings of nonenhanced anaplastic astrocytoma in a 30-year-old woman. Brain magnetic resonance imaging showed a nonenhanced brain tumor with mild peritumoral edema on the right medial frontal lobe and right genu of corpus callosum, suggesting a low-grade glioma. However, PWI showed increased relative cerebral blood volume, relative cerebral blood flow, and permeability of nonenhanced brain tumor compared with contralateral normal brain parenchyma, suggesting a high-grade glioma. After surgery, final histopathological analysis revealed World Health Organization grade III anaplastic astrocytoma. This case demonstrates the importance of PWI for preoperative evaluation of nonenhanced brain tumors.

• The Journal of the Korea Contents Association
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• v.5 no.5
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• pp.296-304
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• 2005

Quantitative analysis compare to dynamic characteristic change of the regional cerebral blood volume(rCBV) after development of cerebral fat embolism in cats using perfusion magnetic resonance(MR) Imaging. Twenty cats were used. Linoleic acid (n=11) were injected into the internal carotid artery using microcatheter through the transfemoral approach. Polyvinyl alcohol (Ivalon) (n=9) was injected as a control group. Perfusion MR images were obtained at 30 minutes and 2 hours after embolization, based on T2 and diffusion-weighted images. The data was time-to-signal intensity curve and ${\Delta}R_2^*$ curve were obtained continuously with the aid of home-maid image process algorithm and IDL(interactive data Banguage, USA) softwares. The ratios of rCBV increased significantly at 2 hours compared with those of 30 minutes (P<0.005). In conclusion, cerebral blood flow decreased in cerebral fat embolism immediately after embolization and recovered remarkably in time course. It is thought that clinically informations to dynamic characteristic change of the cerebral hemodynamics to the early finding in cerebral infarction by diffusion weighted imaging(DWI) and perfusion weighted imaging(PWI).

• Investigative Magnetic Resonance Imaging
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• v.7 no.2
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• pp.116-123
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• 2003

Purpose : The present study was undertaken to evaluate the usefulness of cerebral diffusion (DWI) and perfusion MR imaging (PWI) in rabbit models with hyperacute cerebral ischemic infarction. Materials and Methods : Experimental cerebral infarction were induced by direct injection of mixture of Histoacryl glue, lipiodol, and tungsten powder into the internal cerebral artery of 6 New-Zealand white rabbits, and they underwent conventional T1 and T2 weighted MR imaging, DWI, and PWI within 1 hour after the occlusion of internal cerebral artery. The PWI scan for each rabbit was obtained at the level of lateral ventricle and 1cm cranial to the basal ganglia. By postprocessing using special imaging software, perfusion images including cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) maps were obtained. The detection of infarcted lesion were evaluated on both perfusion maps and DWI. MTT difference time were measured in the perfusion defect lesion and symmetric contralateral normal cerebral hemisphere. Results : In all rabbits, there was no abnormal signal intensity on T2WI. But on DWI, abnormal high signal intensity, suggesting cerebral infarction, were detected in all rabbits. PWI (rCBV, CBF and MTT map) also showed perfusion defect in all rabbits. In four rabbits, the calculated square of perfusion defect in MTT map is larger than that of CBF map and in two rabbits, the calculated size of perfusion defect in MTT map and CBF map is same. Any rabbits do not show larger perfusion defect on CBF map than MTT map. In comparison between CBF map and DWI, 3 rabbits show larger square of lesion on CBF map than on DWI. The others shows same square of lesion on both technique. The size of lesion shown in 6 MTT map were larger than DWI. In three cases, the size of lesion shown in CBF map is equal to DWI. But these were smaller than MTT map. The calculated square of lesion in CBF map, equal to that of DWI and smaller than MTT map was three. And in one case, the calculated square of perfusion defect in MTT map was largest, and that of DWI was smallest. Conclusion : DWI and PWI may be useful in diagnosing hyperacute cerebral ischemic infarction and in e-valuating the cerebral hemodynamics in the rabbits.

• Journal of Biomedical Engineering Research
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• v.25 no.4
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• pp.243-251
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• 2004

This study was to quantitative analysis compare to dynamic characteristic change of the regional cerebral blood volume (rCBV) after development of cerebral fat embolism in cats using perfusion MR Imaging. Forty-four adult rats were used. Triolein (n = 15), oleic acid (n = 9) and linoleic acid (n = 11) were injected into the internal carotid artery using microcatheter through the transfemoral approach. Polyvinyl alcohol (Ivalon) (n = 9) was injected as a control group. Perfusion MR images were obtained at 30 minutes and 2 hours after embolization, based on T2 and diffusion-weighted images. The data was time-to-signal intensity curve and ΔR$_2$＊ curve were obtained continuously with the aid of home-maid image proc in.leased significantly at 2 hours compared with those of 30 minutes (P＜0.005). In conclusion, cerebral blood flow decreased in cerebral fat embolism immediately after embolization and recovered remarkably in time course. It is thought that clinically informations to dynamic characteristic change of the cerebral hemodynamics to the early finding in cerebral infarction by DWI and PWI

• Proceedings of the KSMRM Conference
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• 2001.11a
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• pp.170-170
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• 2001

Purpose： To evaluate the relationship between reperfusion hyperemia in reversible cerebral ischem and the degree of programmed cell death. Method： We produced the animal models of reversible cerebral ischemia in 10 cats by mean of middle cerebral artery (MCA) occlusion with transorbital approach. MCA was occluded b microvascular clamp for an hour. MR imaging was performed at 0, 1, 2 days after ischemi and reperfusion. Perfusion (PWI) [Contrast enhanced GRE EPI, TR/TE= 1500/40, 40 Phases, 128 matrix, 12 cm FOV] and diffusion (DWI) (SE EPI, b=0, 500, 1000) weighted images were obtained using Philips Intera 1.57 system. rCBV and ADC maps were calculated wi IDL based postprocessing program. Tissue slices were obtained after the last MR imagin TUNEL, Calbin and Acid-Fuscin staining were done for corresponding slices as MR imagin We investigated the differences of degree of apoptosis in the area of reperfusion hyperemia.

• 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.

• Investigative Magnetic Resonance Imaging
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• v.18 no.2
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• pp.120-132
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• 2014

Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weighted imaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patients treated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newly appearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions were confirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume (nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for the enhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regression model was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtained from receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy for the diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004), and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference was observed in the mean ADC values between the two groups. A multivariable logistic regression analysis showed that proSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11 of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesions more than one year after RT completion in brain tumor patients.

• Investigative Magnetic Resonance Imaging
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• v.21 no.1
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• pp.9-19
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• 2017

Background: Normalized cerebral blood volume (nCBV) can be measured using manual or semiautomatic segmentation method. However, the difference in diagnostic performance on brain tumor differentiation between differently measured nCBV has not been evaluated. Purpose: To compare the diagnostic performance of manually obtained nCBV to that of semiautomatically obtained nCBV on glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) differentiation. Materials and Methods: Histopathologically confirmed forty GBM and eleven PCNSL patients underwent 3T MR imaging with dynamic susceptibility contrast-enhanced perfusion MR imaging before any treatment or biopsy. Based on the contrast-enhanced T1-weighted imaging, the mean nCBV (mCBV) was measured using the manual method (manual mCBV), random regions of interest (ROIs) placement by the observer, or the semiautomatic segmentation method (semiautomatic mCBV). The volume of enhancing portion of the tumor was also measured during semiautomatic segmentation process. T-test, ROC curve analysis, Fisher's exact test and multivariate regression analysis were performed to compare the value and evaluate the diagnostic performance of each parameter. Results: GBM showed a higher enhancing volume (P = 0.0307), a higher manual mCBV (P = 0.018) and a higher semiautomatic mCBV (P = 0.0111) than that of the PCNSL. Semiautomatic mCBV had the highest value (0.815) for the area under the curve (AUC), however, the AUCs of the three parameters were not significantly different from each other. The semiautomatic mCBV was the best independent predictor for the GBM and PCNSL differential diagnosis according to the stepwise multiple regression analysis. Conclusion: We found that the semiautomatic mCBV could be a better predictor than the manual mCBV for the GBM and PCNSL differentiation. We believe that the semiautomatic segmentation method can contribute to the advancement of perfusion based brain tumor evaluation.

• Investigative Magnetic Resonance Imaging
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• v.20 no.2
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• pp.105-113
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• 2016

Purpose: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. Materials and Methods: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. Results: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. Conclusion: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.