• Journal of Medicine and Life Science
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• v.15 no.2
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• pp.89-94
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• 2018

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is inherited microangiopathy caused by mutations in the Notch3 gene. Typical findings from brain magnetic resonance imaging (MRI) include subcortical lacunes, extensive white matter change and cerebral microbleeds(CMBs). CMBs are indicative of bleeding-prone microangiopathy. Despite some studies investigating the association between lacunes and cognitive dysfunction in CADASIL, few studies have examined the relationship between cognitive dysfunction and CMBs. We sought to assess whether CMBs are associated with cognitive dysfunction in CADASIL. This study enrolled 83 consecutive patients with CADASIL between April 2012 and January 2014. Their degree of cognitive dysfunction was assessed by the Korean version of the CERAD neuropsychological assessment battery, digit span test, and the Stroop test. A 3.0-T MRI was used to obtain T1-weighted, fluid-attenuated inversion recovery, and susceptibility weighted images. In multiple logistic regression analysis, the grade of CMBs influenced tests of memory dysfunction (p=0.003). Three or more lacunes correlated with dysfunction in the executive domain (p=0.013) and attention domain (p=0.005). White matter hyperintensity (WMH) was an independent predictor of executive dysfunction (p=0.001). These findings suggest that in addition to lacunes, CMBs and WMHs may be useful imaging markers to associated with cognitive dysfunction in CADASIL.

• Investigative Magnetic Resonance Imaging
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• v.11 no.2
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• pp.103-109
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• 2007

To develop an advanced non-linear curve fitting (NLCF) algorithm for performing dynamic susceptibility contrast study of the brain. The first pass effects give rise to spuriously high estimates of $K^{trans}$ for the voxels that represent the large vascular components. An explicit threshold value was used to reject voxels. The blood perfusion and volume estimation were accurately evaluated in the $T2^*$-weighted dynamic contrast enhanced (DCE)-MR images. From each of the recalculated parameters, a perfusion weighted image was outlined by using the modified non-linear curve fitting algorithm. The present study demonstrated an improvement of an estimation of the kinetic parameters from the DCE $T2^*$-weighted magnetic resonance imaging data with using contrast agents.

• 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.

• 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.17 no.4
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• pp.275-285
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• 2013

Purpose : The objective of this study was to investigate effects of different smoothing kernel sizes on brain tissue-masked susceptibility-weighted images (SWI) obtained from normal elderly subjects using voxel-based analyses. Materials and Methods: Twenty healthy human volunteers (mean $age{\pm}SD$ = $67.8{\pm}6.09$ years, 14 females and 6 males) were studied after informed consent. A fully first-order flow-compensated three-dimensional (3D) gradient-echo sequence ran to obtain axial magnitude and phase images to generate SWI data. In addition, sagittal 3D T1-weighted images were acquired with the magnetization-prepared rapid acquisition of gradient-echo sequence for brain tissue segmentation and imaging registration. Both paramagnetically (PSWI) and diamagnetically (NSWI) phase-masked SWI data were obtained with masking out non-brain tissues. Finally, both tissue-masked PSWI and NSWI data were smoothed using different smoothing kernel sizes that were isotropic 0, 2, 4, and 8 mm Gaussian kernels. The voxel-based comparisons were performed using a paired t-test between PSWI and NSWI for each smoothing kernel size. Results: The significance of comparisons increased with increasing smoothing kernel sizes. Signals from NSWI were greater than those from PSWI. The smoothing kernel size of four was optimal to use voxel-based comparisons. The bilaterally different areas were found on multiple brain regions. Conclusion: The paramagnetic (positive) phase mask led to reduce signals from high susceptibility areas. To minimize partial volume effects and contributions of large vessels, the voxel-based analysis on SWI with masked non-brain components should be utilized.

• Investigative Magnetic Resonance Imaging
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• v.19 no.2
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• pp.76-87
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• 2015

Purpose: There is an ongoing search for a stent material that produces a reduced susceptibility artifact. This study evaluated the effect of manganese (Mn) content on the MRI susceptibility artifact of ferrous-manganese (Fe-Mn) alloys, and investigated the correlation between MRI findings and measurements of Fe-Mn microstructure on X-ray diffraction (XRD). Materials and Methods: Fe-Mn binary alloys were prepared with Mn contents varying from 10% to 35% by weight (i.e., 10%, 15%, 20%, 25%, 30%, and 35%; designated as Fe-10Mn, Fe-15Mn, Fe-20Mn, Fe-25Mn, Fe-30Mn, and Fe-35Mn, respectively), and their microstructure was evaluated using XRD. Three-dimensional spoiled gradient echo sequences of cylindrical specimens were obtained in parallel and perpendicular to the static magnetic field (B0). In addition, T1-weighted spin echo, T2-weighted fast spin echo, and $T2^*$weighted gradient echo images were obtained. The size of the low-intensity area on MRI was measured for each of the Fe-Mn binary alloys prepared. Results: Three phases of ${\alpha}^{\prime}$-martensite, ${\gamma}$-austenite, and ${\varepsilon}$-martensite were seen on XRD, and their composition changed from ${\alpha}^{\prime}$-martensite to ${\gamma}$-austenite and/or ${\varepsilon}$-martensite, with increasing Mn content. The Fe-10Mn and Fe-15Mn specimens comprised ${\alpha}^{\prime}$-martensite, the Fe-20Mn and Fe-25Mn specimens comprised ${\gamma}+{\varepsilon}$ phases, and the Fe-30Mn and Fe-35Mn specimens exhibited a single ${\gamma}$ phase. The size of the low-intensity areas of Fe-Mn on MRI decreased relative to its microstructure on XRD with increasing Mn content. Conclusion: Based on these findings, proper conditioning of the Mn content in Fe-Mn alloys will improve its visibility on MR angiography, and a Mn content of more than 25% is recommended to reduce the magnetic susceptibility artifacts on MRI. A reduced artifact of Fe-Mn alloys on MRI is closely related to the paramagnetic constitution of ${\gamma}$-austenite and/or ${\varepsilon}$-martensite.

• Korean Journal of Digital Imaging in Medicine
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• v.9 no.2
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• pp.11-16
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• 2007

We have evaluated and compared of gradient echo and spin echo EPI for compensating about deeply distortion aspect in case of post-operation patients in magnetic resonance image. A total of 100 patients were performed on 3.0 T(GE Signa Excite E2, USA) with 8ch head coil. As a result of analysis, The SNRs of whiter and gray matter areas were 36.74 $\pm$ 06 and 39.96 $\pm$ 09 in the gradient echo EPI, the SNRs which white and gray matter areas were slightly higher than gradient echo EPI(P<0.005, paired student t-test). It was 46.24 $\pm$ 11 and 51.38 $\pm$ 13 in gradient and spin echo EPI, respectively. The signal intensity in the whiter and gray matter areas also were 87.33 $\pm$ 15.24 and 140.66 $\pm$ 13.45 in the gradient echo EPI techniques, The signal intensity of gradient echo EPI showed higher values compared to spin echo EPI. Otherwise, gradient echo EPI technique is distortion enough to operation wound and edge of the image, while spin echo EPI technique did not appear almost. In this point, the spin echo EPI technique, after surgical operation according to patient state beside gradient echo EPI techniques that signalbeside gradient echo EPI techniques that signal intensity is high and patient's case which image distortion is serious by metal etc, will be provide the useful information in adults and pediatric patients.

• Korean Journal of Digital Imaging in Medicine
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• v.14 no.1
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• pp.31-35
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• 2012

To test the real image quality of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) techniquein clinical abdominal MRI by comparison to turbo spin echo inversion-recovery (TSEIR) fat-suppression (FS) technique. 3.0T MRI studies of the abdomen were performed in 30 patients with liver lesions (hemangiomas n: 15; HCC n: 15). T2W sequences were acquired using SPAIR TSEIR. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects. SPAIR-TSEIR images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR were 20.5, 10.2 and TSEIR were 43.2, 24.1 (P<0.05). SPAIR-TSEIR images produced higher CNR for both hemangiomas CNR 164.88 vs 126.83 (P<0.05) and metastasis CNR 75.27 vs 53.19 (P<0.05). Bowel wall visualization was significantly improved using in both SPAIR-TSEIR (P< 0.05). The real image quality of SPAIR was better than over conventional TSEIR FS on clinical abdominal MRI scans.

• Investigative Magnetic Resonance Imaging
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• v.20 no.1
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• pp.44-52
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• 2016

Purpose: To quantitatively and qualitatively compare fat-suppressed MRI quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using frequency selective fat-suppression (FSFS) T2- and postcontrast T1-weighted fast spin-echo images of the head and neck at 3T. Materials and Methods: The study was approved by our Institutional Review Board. Prospective MR image analysis was performed in 36 individuals at a single-center. Axial fat suppressed T2- and postcontrast T1-weighted images with IDEAL and FSFS were compared. Visual assessment was performed by two independent readers with respect to; 1) metallic artifacts around oral cavity, 2) susceptibility artifacts around upper airway, paranasal sinus, and head-neck junction, 3) homogeneity of fat suppression, 4) image sharpness, 5) tissue contrast of pathologies and lymph nodes. The signal-to-noise ratios (SNR) for each image sequence were assessed. Results: Both IDEAL fat suppressed T2- and T1-weighted images significantly reduced artifacts around airway, paranasal sinus, and head-neck junction, and significantly improved homogeneous fat suppression in compared to those using FSFS (P < 0.05 for all). IDEAL significantly decreased artifacts around oral cavity on T2-weighted images (P < 0.05, respectively) and improved sharpness, lesion-to-tissue, and lymph node-to-tissue contrast on T1-weighted images (P < 0.05 for all). The mean SNRs were significantly improved on both T1- and T2-weighted IDEAL images (P < 0.05 for all). Conclusion: IDEAL technique improves image quality in the head and neck by reducing artifacts with homogeneous fat suppression, while maintaining a high SNR.

• Investigative Magnetic Resonance Imaging
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• v.18 no.4
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• pp.332-340
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• 2014

Purpose : A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signals in the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas of impaired perfusion and to investigate the usefulness of PHSV in predicting prognosis of cerebral infarction. Materials and Methods: In 18 patients with acute cerebral infarction who underwent brain MRI with diffusion-weighted imaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacent to areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normal appearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change in the extent of infarction in follow-up images was analyzed. Results: Of the 18 patients, 10 patients showed progression of the infarction, and 8 patients showed little change on follow- up imaging. On SWI, of the 10 patients with progression 9 patients showed peripheral PHSV and the newly developed infarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSV showed progression of the infarct. The patients with infarction progression revealed significantly higher presence of peripheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients with little change. Conclusion: SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict the prognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predicting prognosis of acute cerebral infarction.