• 대한디지털의료영상학회논문지
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• 제15권1호
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• pp.1-7
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• 2013

Purpose : The Carotid Angio inspection including Aortic arch applied to wide area is conducted as the Contrast Enhance MR Angiography(CEA) which is using a contrast medium. However it is a burden not only for someone such as infants, pregnant women and patients suffering from kidney failure but continuous use of contrast medium also can be a burden for patients who has been taken follow up inspection since diagnose lesion already. The purpose of this study is to estimate a usefulness of the Time of Flight (TOF) by comparing with CEA. Materials and methods : 10 patients with an average age of 58 (from 45 to 75) who had MRA inspection in our hospital were studied using 3.0 Tesla Aachieva (Philips, Netherland) MRI system and Sense Neuro-Vascular 16 Channels Coil. The same patient was inspected both TOF and CEA simultaneously. The TOF inspection included from Aortic arch to Willis Circle by connecting 3 TOF stacks and so did CEA inspection. The quantitative analysis was conducted through signal to noise ratio(SNR) and contrast to noise ratio(CNR) with soft tissue by setting up an area of interest on CCA bifurcatoin, ICA, ECA, MCA and VA concerning obtained image. In case of qualitative analysis, 3 radiological technologists and 1 radiologist evaluated 4 items (1: Visibility of the blood vessel, 2: Image distortion measure, 3: Overlapping measure with vein, 4: Peripheral blood vessel description measure) into five points scale (1: Very bad, 2: Bad, 3: Normal 4: Good, 5: Very good). Results : Results for the quantitative analysis was obtained by calculating the average of 5 ROIs in case of SNR and CNR separately. Results of SNR, TOF were generally measured higher than CEA (In case of TOF were 166.1, 205.2, 154.39, 172.23, 161.95, and CEA were 92.05, 95.43, 84.76, 73.69, 88.3). But according to the result of CNR, both TOF and CEA were measured similarly as 67.62, 106.71, 55.9, 73.74, 63.46 for TOF and 67.82, 71.19, 60.52, 49.45, 64.07 for CEA. Throughout every results of each ROI, SNR showed statistically meaningful consequence (0.050.05). In case of qualitative analysis the average of each evaluated item was 4.2points and 4.28points in the item1, 2.93points and 4.55points in the item2, 4.6points and 3.13points in the item3, 2.88points and 4.6points in the item4. According to the results TOF was measured higher in the item3 while in the item2 and item4 CEA was higher and in case of the item1, both CEA and TOF were similar. To sum up statistically meaningful results (p<0.05) were shown in the item2, item3 and item4 but not in the item1 (p>0.05). Conclusions : Both TOF and CEA are complementary because each inspection has pros and cons, but when inspect wide area including Aortic arch normally CEA is conducted. But TOF inspection also can be considered as alternative in terms of patients who has difficulty in the contrast medium such as infants, pregnant women and patients suffering from kidney failure and patients during follow up.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.367-369
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• 2002

We have designed ramp profile excitation pulse based on the Shinnar-Le Roux (SLR) algorithm. The algorithm provides many advantages to pulse designers. The first advantage is the freedom of deciding the amplitudes, frequencies, and ripple sizes of stopband, passband, and transition band of pulse profile. The second advantage is the freedom of deciding the pulse phase, more specifically, minimum phase, linear phase, maximum phase, and any phase between them. The minimum phase pulse is the best choice in the case of 3D TOF, because it minimizes the echo time, which implies the best image quality in the same MR examination condition. In addition, the half echo technique is slightly modified in our case. In general, using the half echo technique means that the acquired data size is half and the rest part can be filled with complex conjugate of acquired data. But in our case, the echo center is just shifted to left, which implies the reduction of echo time, and the acquired data size is the same as the one without using the half echo technique. In this case, the increase of right part of data leads to improvement of the resolution and the decrease of left part of data leads to decrease of signal to noise ratio. Since in the case of 3D TOF, the signal to noise ratio is sufficiently high and the resolution is more important than signal to noise ratio, the proposed method appears to be significantly affective and gives rise to the improved high resolution angiograms.

• Investigative Magnetic Resonance Imaging
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• 제9권2호
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• pp.94-100
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• 2005

목적 : 뇌혈관 평가에 있어서 경두개 도플러 초음파(transcranial doppler; TCD)와 고식적 뇌혈관조영술(CA)과 비교하여 3T 장비를 이용한 Time-of-flight(TOF) 자기공명 뇌혈관 조영술(3T-TOF MRA)의 유용성에 대해 알아보고자 하였다. 대상 및 방법 : 뇌혈관 질환이 의심된 54명의 환자를 대상으로 3T-TOF MRA를 시행하였다. 54명 모두에서 TCD를 시행하였으며, 이중 11명은 CA를 함께 시행하였다. 뇌혈관의 평가를 위해 추골동맥과 기저동맥을 포함하여 I군, 총경동맥의 분지부위 2 cm 전부터 내 외경동맥 분지 부위에서 내경동맥의 무릎(genu)부위 까지를 II군, 내경동맥의 추체부위에서 전 중 대뇌동맥의 1차분지 부위까지를 III군, 그리고 각각 전 중 대뇌동맥 1차분지 그 이하 부위를 IV군으로 임의로 구분하였다. 평가는 2명의 방사선과 의사가 3T-TOF MRA와 TCD, 그리고 CA의 결과를 모르는 상태에서 각 군에서 혈관의 양상이 잘 나타나는 경우를 3점, 양상이 잘 나타나지 않으나 판독이 가능한 경우를 2점, 잡상 등으로 혈관의 평가가 어려운 경우를 1점으로 하였다. 혈관의 협착 정도에 대한 평가는 TCD 및 CA와 각각 비교하여 그 일치 정도를 평가하였다. 결과 : 각 군당 좌우를 합하여 108 혈관분절, 총 432 혈관분절을 평가하였다. 정성평가에서 I, II, III, IV군은 각각 2.98, 2.96, 2.91, 2.88로 혈관의 양상에 대한 파악은 잘 되는 것으로 나타났다. TCD만을 시행한 43명 중 41명에서 3T-TOF MRA와 TCD가 일치하였고, TCD와 CA를 모두 함께 시행한 11명에서는 3T-TOF MRA가 TCD 및 CA와 모두 일치하였다. 결론 : 3T-TOF MRA는 뇌혈관 평가에 있어서 CA 및 TCD와 비교해서 빠르고 비침습적이며 혈관상태를 적절하게 평가할 수 있는 유용한 검사라고 생각한다.

• Investigative Magnetic Resonance Imaging
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• 제2권1호
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• pp.83-88
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• 1998

목적 : 저자는 생체의 방추형 동맥류를 단순화 시킨 비박동성 방추형 유체 모형을 이용하여 방추형 유체의 자기공명 혈과조영술의 신호강도를 분석하고 컴퓨터를 이용한 유체의 모의 실험과 비교하여 임상적으로 방추형 동맥류의 자기공명 혈관조영술의 신호강도의 해석에 도움이 되는 자료를 얻고자 하였다. 대상 및 방법 : 증류수를 유체로 이용한 비박동성 방추형 동맥류 유체 모형에서 3D TOF MRA를 촬영하여 영상을 얻고 각 영상에서 유체의 평균 신호강도를 측정하였으며, 컴퓨터에서 동일 형태의 방추형 유체를 모의 실험하여 유속의 분포, 방향을 얻어 비교 분석하였다. 결과 : 자기공명 혈관조영술에서 방추형 유체의 유입부와 유출부의 신호강도는 균질한 신호 강도를 보였으나, 팽대부에서는 비균질한 신호강도를 보였으며, 유출부로의 이행부위에서는 중심부 저신호강도, 주변부 고신호강도의 과녁 모야으로 보였다. 방추형 유체의 평균 신호강도는 팽대부에서 서서히 감소하다가 유출부로의 이행 부위에서 급속히 감소하였다가 회복되어 유출부에서는 유입부와 같은 정도의 신호강도를 보였다. 컴퓨터를 이용한 모의실험에서 유입부와 유출부에서는 층류의 소견이었으며, 유입부 이행부위 빛 팽대부에서는 유속의 감소와 주변부로의 방향변화가 있었다. 유출부로의 이행부위에서는 유속이 급속히 회복되었고, 중심부분으로의 방향 변화가 현저하였다. 결론 : 방추형 유체는 자기공명 혈관조영술에서 유출부로의 이행부위에서 신호소실과 과녁모양을 보이며, 이는 급격한 유속증가 및 방향 변화에 따른 위상 전위 때문이다.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.398-404
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• 2019

Objective : Recently, three-dimensional (3D) printed models of the intracranial vascular have served as useful tools in simulation and training for cerebral aneurysm clipping surgery. Precise and realistic 3D printed aneurysm models may improve patients' understanding of the 3D cerebral aneurysm structure. Therefore, we created patient-specific 3D printed aneurysm models as an educational and clinical tool for patients undergoing aneurysm clipping surgery. Herein, we describe how these 3D models can be created and the effects of applying them for patient education purpose. Methods : Twenty patients with unruptured intracranial aneurysm were randomly divided into two groups. We explained and received informed consent from patients in whom 3D printed models-(group I) or computed tomography angiography-(group II) was used to explain aneurysm clipping surgery. The 3D printed intracranial aneurysm models were created based on time-of-flight magnetic resonance angiography using a 3D printer with acrylonitrile-butadiene-styrene resin as the model material. After describing the model to the patients, they completed a questionnaire about their understanding and satisfaction with aneurysm clipping surgery. Results : The 3D printed models were successfully made, and they precisely replicated the actual intracranial aneurysm structure of the corresponding patients. The use of the 3D model was associated with a higher understanding and satisfaction of preoperative patient education and consultation. On a 5-point Likert scale, the average level of understanding was scored as 4.7 (range, 3.0-5.0) in group I. In group II, the average response was 2.5 (range, 2.0-3.0). Conclusion : The 3D printed models were accurate and useful for understanding the intracranial aneurysm structure. In this study, 3D printed intracranial aneurysm models were proven to be helpful in preoperative patient consultation.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.5-10
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• 2009

Objective : Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms. Methods : From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively. Results : After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5. Conclusion : Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.

• 대한디지털의료영상학회논문지
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• 제14권1호
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• pp.7-12
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• 2012

The purpose of this study was to examine usefulness of 3T equipment-based time-of-flight magnetic resonance angiography (3T-TOF MRA) by comparing standard technique (ST) with high resolution technique (HRT) in evaluation of cerebral blood vessel. The 3T-TOF MRA was performed for 31 patients who were suspected of having cerebrovascular disease from March to July 2010. For evaluation of cerebral blood vessel, classification was conducted randomly: group I that included vertebral artery and basilar artery, group II that ranged from 2.5cm before basin part of common carotid artery to basin part of internal and external carotid arteries and to genu part of internal carotid artery, group III that ranged from vertebral part of internal carotid artery to the first basin art of anterior and middle cerebral through education recognizes the importance of dose reduction and examine if their efforts and further reduce patient dose could achieve optimization of the medical exposure is considered.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.85-91
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• 2012

Objective : Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD. Methods : There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS. Results : The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028). Conclusion : Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery.

• 대한방사선기술학회지:방사선기술과학
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• 제30권3호
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• pp.265-270
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• 2007

뇌경색환자들에 있어서 CE-TOF-MRA에서 MT 펄스사용의 유용성을 알아보고자 하였다. 2007년 5월에서 6월까지 뇌경색 증상 발현 후 최소 4시간에서 최대 5일 이내에 환자 10명을 대상으로 3Tesla 자기공명영상기기를 사용하여 조영제 주입 후 offset frequency 0, 600, 1,200, 1,800 Hz의 MT 펄스를 사용한 CE-TOF-MRA을 획득하였다. TOF-SPGR기법인 CE-TOF-MRA영상에서 정상혈관의 경우 SNR이 감소되었지만 CNR은 증가를 보였다. 좁아진 혈관부위는 MT 펄스 600 Hz, 1,200 Hz에서 최고의 CNR을 보였고, 협착된 혈관에서는 MT 펄스 강도와 비례하여 CNR이 증가 하였다. 혈관이 폐색된 경우에는 폐색범위가 명확하게 나타났고 MT 펄스 1,800 Hz에서 최고의 CNR로 평가되었다. 좁아지거나 보이지 않는 혈관에서는 형태변화가 없었고, 혈관이 폐색되어 평가가 불가능한 혈관에서 MT 펄스 후 혈관과 배후조직 SNR은 다소 감소하였지만 두 조직간 CNR은 증가되었다.

• 한국자기학회지
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• 제26권3호
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• pp.92-98
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• 2016

신호증강효과기법을 이용한 자기공명혈관술에서 뇌동맥을 half scan factor에 따른 절반스캔과 완전스캔의 영상을 평가하는데 목적으로 한다. 뇌혈관성 질환이 없는 환자(n = 30)를 대상으로 절반스캔과 완전스캔 하였고, 뇌동맥의 관심영역을 세 영역(C1, C2, C3)에서 7~8 mm의 범위로 설정하였다. MIP로 재구성한 영상으로 신호강도를 SNR(signal to noise ration), PSNR(peak signal noise to ratio), RMSE(root mean square error), MAE(mean absolute error)을 산출하고 paired t-test를 이용하여 통계분석 하였다. 스캔시간은 절반스캔(4분 53초), 완전스캔(6분 04초)이었다. 뇌혈관의 모든 ROI의 평균 측정 범위(7.21 mm)이었고, 첫번째 C1의 SNR은 완전스캔(58.66 dB), 절반스캔(62.10 dB)이었고, 양의 상관관계($r^2=0.503$)이고, 두 번째 C2의 SNR은 완전스캔(70.30 dB), 절반스캔(74.67 dB)이고 양의 상관관계($r^2=0.575$)이었다. 세 번째 C3의 완전스캔 SNR(70.33 dB), 절반스캔 SNR (74.64 dB)로 양의 상관관계를 ($r^2=0.523$)로 분석되었다. 절반스캔과 완전스캔의 비교에서 SNR($4.75{\pm}0.26dB$), PSNR($21.87{\pm}0.28dB$), RMSE($48.88{\pm}1.61$)이었고 MAE($25.56{\pm}2.2$)로 산출되었다. SNR은 두 검사 스캔에서 통계학적으로 유의하지 않았고 (p-value > .05) 영상의 질에서는 많은 차이가 없어 완전스캔을 사용하였을 때보다 적은 시간이 소요되는 절반스캔을 적용하여 검사하여도 된다.