• Korean Journal of Radiology
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• v.22 no.3
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• pp.395-404
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• 2021

Objective: To compare the utility of computed tomography perfusion (CTP) and three different 4-point scoring systems in computed tomography angiography (CTA) in confirming brain death (BD) in patients with and without skull defects. Materials and Methods: Ninety-two patients clinically diagnosed as BD using CTA and/or CTP for confirmation were retrospectively reviewed. For the final analysis, 86 patients were included in this study. Images were re-evaluated by three radiologists according to the 4-point scoring systems that consider the vessel opacification on 1) the venous phase for both M4 segments of the middle cerebral arteries (MCAs-M4) and internal cerebral veins (ICVs) (A60-V60), 2) the arterial phase for the MCA-M4 and venous phase for the ICVs (A20-V60), 3) the venous phase for the ICVs and superior petrosal veins (ICV-SPV). The CTP images were independently reviewed. The presence of an open skull defect and stasis filling was noted. Results: Sensitivities of the ICV-SPV, A20-V60, A60-V60 scoring systems, and CTP in the diagnosis of BD were 89.5%, 82.6%, 67.4%, and 93.3%, respectively. The sensitivity of A20-V60 scoring was higher than that of A60-V60 in BD patients (p < 0.001). CTP was found to be the most sensitive method (86.5%) in patients with open skull defect (p = 0.019). Interobserver agreement was excellent in the diagnosis of BD, in assessing A20-V60, A60-V60, ICV-SPV, CTP, and good in stasis filling (κ: 0.84, 0.83, 0.83, 0.83, and 0.67, respectively). Conclusion: The sensitivity of CTA confirming brain death differs between various proposed 4-point scoring systems. Although the ICV-SPV is the most sensitive, evaluation of the SPV is challenging. Adding CTP to the routine BD CTA protocol, especially in cases with open skull defect, could increase sensitivity as a useful adjunct.

• Journal of Animal Reproduction and Biotechnology
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• v.35 no.3
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• pp.265-267
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• 2020

The congenital head anomalies are most often used to describe defects in the eyes, mouth, nose, skull, and or brain. The faulty embryogenesis most likely found to be associated with abnormal genetic or epigenetic causes during pregnancy. Eventually it leads to congenital anomalies. Rabbit-headed Lamb (RH) is a disorder in sheep breeding that is characterized by some deformities in the head and the face. A dead -day old- crossbred white Najdi lamb with a deformed face and head was reported to be born in the current case. The external and physical examination revealed a deformed skull and facial region with a unilateral eye, fused mouth, pig-like nose, and patent skull with the brain coming out from left eye orbit. Additionally, the lamb was very skinny with unusual long extremities. This is the first report of this syndrome that describes such deformities in a stillbirth Najdi breed lamb.

• Korean Journal of Computational Design and Engineering
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• v.17 no.3
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• pp.198-207
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• 2012

This paper presents an overview of automated robotic system for skull drilling, which is performed to access for some neurosurgical interventions, such as brain tumor resection. Currently surgeons use automatic-releasing cranial perforators. The drilling procedure must be performed very carefully to avoid penetration of brain nerve structures; however failure cases are reported. The presented prototype system utilizes both preoperative and intraoperative information. Preoperative CT image is used for robot path planning. A NeuroMate robot with a six-DOF force sensor at the end effector is used for intraoperative operation. Intraoperative cutting force from the force sensor is the key information to revise an initial registration and preoperative path plans. Some possibilities are verified by path simulation but cadaver experiments are required for validation of this prototype.

• Transactions on Electrical and Electronic Materials
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• v.15 no.4
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• pp.230-234
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• 2014

Automatic detection of disease helps medical institutions that are introducing digital images to read images rapidly and accurately, and is thus applicable to lesion diagnosis and treatment. The aim of this study was to apply a symmetry contribution algorithm to unsharp mask filter-applied MR images and propose an analysis technique to automatically recognize brain tumor and edema. We extracted the skull region and drawed outline of the skull in database of images obtained at P University Hospital and detected an axis of symmetry with cerebral characteristics. A symmetry contribution algorithm was then applied to the images around the axis of symmetry to observe intensity changes in pixels and detect disease areas. When we did not use the unsharp mask filter, a brain tumor was detected in 60 of a total of 95 MR images. The disease detection rate for the brain was 63.16%. However, when we used the unsharp mask filter, the tumor was detected in 87 of a total of 95 MR images, with a disease detection rate of 91.58%. When the unsharp mask filter was used in the pre-process stage, the disease detection rate for the brain was higher than when it was not used. We confirmed that unsharp mask filter can be used to rapidly and accurately to read many MR images stored in a database.

• Proceedings of the Korea Information Processing Society Conference
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• 2010.11a
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• pp.668-671
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• 2010

In this paper, we present a novel automatic algorithm for scalp and skull segmentation in T1-weighted head MR images. First, the scalp and skull part are constructed by using intensity threshold. Second, the scalp outer surface is extracted based on an active level set method. Third, the skull inner surface is extracted using a canny edge detection algorithm. Finally, the fast sweeping, tagging and level set methods are applied to reconstruct surfaces from the detected points in three-dimensional space. The results of the new segmentation algorithm on MRI data acquired from eight persons were compared with manual segmented data. The average similarity indices for the scalp and skull segmented regions were equal to 84.42% for the test data.

• Journal of the Institute of Electronics Engineers of Korea SP
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• v.49 no.1
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• pp.81-87
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• 2012

The current defacing method for keeping an anonymity of brain images damages the integrity of a precise brain analysis due to over removal, although it maintains the patients' privacy. A novel method has been developed to create an anonymous face model while keeping the voxel values of an image exactly the same as that of the original one. The method contains two steps: construction of a mockup brain template from ten normalized brain images and a substitution of the mockup brain to the brain image. A level set segmentation algorithm is applied to segment a scalp-skull apart from the whole brain volume. The segmented mockup brain is coregistered and normalized to the subject brain image to create an anonymous face model. The validity of this modification is tested through comparing the intensity of voxels inside a brain area from the mockup brain with the original brain image. The result shows that the intensity of voxels inside from the mockup brain is same as ones from an original brain image, while its anonymity is guaranteed.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.4
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• pp.325-334
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• 2008

Statement of problem & Purpose: The purpose of this study was to investigate the effect of a mouth guard material properties on the skull and brain when they were under impact loads on mandible. Material and methods: Two customized mouth protectors having different material propeerst ieach other were made for a female Korean who had no history of brain trauma, no cerebral diseases, nomal occlusion and natural dentition. The 3D finite element model of human skull and brain scanned by means of computed tomography was constructed. The FEM model of head was composed of 407,825 elements and 82,138 nodes, including skull, brain, maxilla, mandible, articular disc, teeth and mouth guard. The stress concentrations on maxillary teeth, maxilla and skull with two mouth guards were evaluated under oblique impact load of 800N onto mandibular 3 loading points for 0.1sec. And the brain relative displacement was compared in two different mouth guard materials under same condition. Result and Conclusion: The results were as follows; 1. In comparison of von Mises stress on maxillary teeth, a soft mouth guard material had significantly lower stress values on measuring point than a hard mouth protector materials (P < .05). 2. In comparison of von Mises stress on maxilla and skull, A soft mouth protector material had significantly lower stress values on measuring point than a hard mouth protector materials (P < .05). 3. For impact loads on mandible, there were more stress concentrated area on maxilla and skull with hard mouth guard than soft with mouth protector. 4. For impact loads on mandible, brain relative displacement had little relation with mouth guard material properties. In results of this study, soft mouth guard materials were superior to hard mouth guard materials for mandible impact loads for prevention of sports injuries. Although the results of this study were not enough to figure out the roles of needed mouth guard material properties for a human head, we got some knowledge of the pattern about stress concentration and distribution on maxilla and skull for impact loads with soft or hard mouth protector. More studies are needed to substantiate the relationship between the mouth guard materials and sports injuries.

• Investigative Magnetic Resonance Imaging
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• v.19 no.3
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• pp.168-177
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• 2015

Purpose: Brain surface intensity model (BSIM)-based cortical thickness analysis does not require complicated 3D segmentation of brain gray/white matters. Instead, this technique uses the local intensity profile to compute cortical thickness. The aim of the present study was to evaluate intra-rater and inter-rater reliability of BSIM-based cortical thickness analysis using images from elderly participants. Materials and Methods: Fifteen healthy elderly participants (ages, 55-84 years) were included in this study. High-resolution 3D T1-spoiled gradient recalled-echo (SPGR) images were obtained using 3T MRI. BSIM-based processing steps included an inhomogeneity correction, intensity normalization, skull stripping, atlas registration, extraction of intensity profiles, and calculation of cortical thickness. Processing steps were automatic, with the exception of semiautomatic skull stripping. Individual cortical thicknesses were compared to a database indicating mean cortical thickness of healthy adults, in order to produce Z-score thinning maps. Intra-class correlation coefficients (ICCs) were calculated in order to evaluate inter-rater and intra-rater reliabilities. Results: ICCs for intra-rater reliability were excellent, ranging from 0.751-0.940 in brain regions except the right occipital, left anterior cingulate, and left and right cerebellum (ICCs = 0.65-0.741). Although ICCs for inter-rater reliability were fair to excellent in most regions, poor inter-rater correlations were observed for the cingulate and occipital regions. Processing time, including manual skull stripping, was $17.07{\pm}3.43min$. Z-score maps for all participants indicated that cortical thicknesses were not significantly different from those in the comparison databases of healthy adults. Conclusion: BSIM-based cortical thickness measurements provide acceptable intra-rater and inter-rater reliability. We therefore suggest BSIM-based cortical thickness analysis as an adjunct clinical tool to detect cortical atrophy.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.212-217
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• 2021

Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-year-old male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient's consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient's transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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• pp.205-207
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• 2014

Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.