Hyun-Jung Lee;Jihoon Kim;Sung-A Chang;Yong-Jin Kim;Hyung-Kwan Kim;Sang Chol Lee
Korean Circulation Journal
/
v.52
no.8
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pp.563-575
/
2022
Hypertrophic cardiomyopathy (HCM) is one of the most common inheritable cardiomyopathies. Contemporary management strategies, including the advent of implantable cardioverter-defibrillators and effective anticoagulation, have substantially improved the clinical course of HCM patients; however, the disease burden of HCM is still high in Korea. Sudden cardiac death (SCD), atrial fibrillation and thromboembolic risk, dynamic left ventricular outflow tract (LVOT) obstruction, and heart failure (HF) progression remain important issues in HCM. SCD in HCM can be effectively prevented with implantable cardioverter-defibrillators. However, appropriate patient selection is important for primary prevention, and the 5-year SCD risk score and the presence of major SCD risk factors should be considered. Anticoagulation should be initiated in all HCM patients with atrial fibrillation regardless of the CHA2DS2-VASc score, and non-vitamin K antagonist oral anticoagulants are the first option. Symptomatic dynamic LVOT obstruction is first treated medically with negative inotropes, and if symptoms persist, septal reduction therapy is considered. The recently approved myosin inhibitor mavacamten is promising. HF in HCM is usually related to diastolic dysfunction, while about 5% of HCM patients show reduced left ventricular ejection fraction <50%, also referred to as "end-stage" HCM. Myocardial fibrosis plays an important role in the progression to advanced HF in patients with HCM. Patients who do not respond to guideline-directed medical therapy can be considered for heart transplantation. The development of imaging techniques, such as myocardial deformation on echocardiography and late gadolinium enhancement on cardiac magnetic resonance, can provide better risk evaluation and decision-making for management strategies in HCM.
Kim, Byoung-Suck;Kim, Woo-Sig;Han, Kyoung-Jin;Cho, Jae-Hyun;Lee, Kyi-Beom;Ha, Heon-Kyo;Kang, Shin-Young
The Journal of the Korean bone and joint tumor society
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v.7
no.1
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pp.28-35
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2001
Purpose : Authors investigated the efficiency of preoperative MRI in suspicious glomus tumor and the clinical outcomes after marginal excision. Materials and Methods : In 10 cases of glomus tumors in the fingers, authors retrospectively analyzed the clinical data, including previous trauma, treatment history, preoperative symptoms, physical examination, plain radiography, MRI (9 cases), pathological findings and postoperative complications. Results : The patients had pain in 10 cases, tenderness in 9 cases, cold sensitivity in 3 cases and edema in one case. MRI showed low signal (3 cases) or iso-signal (5) intensity on T1 weighted image, high signal intensity (8) on T2 weighted image, and all the lesions were enhanced in gadolinium enhancement images. The exact locations of glomus tumors were median in 6 cases, lateral in 5, lateral fold in 2 and pulp in 3 in transverse section and nail bed in 5 cases and nail matrix in 5 in sagittal section. Marginal excision was performed by lateral approach in one case and transungual in 9 cases. Histologically, all 10 cases were composed of solid sheets of round cells interrupted by thin-walled blood vessels. Most of clinical symptoms were disappeared in all cases after operation. Nail deformity was found in one case, which was originated from nail matrix, however, there was no recurrence. Summary : Clinical symptom was the most impotant factor in diagnosis of glomus tumor in the fingers. However, preoperative MRIs were helpful in patients, who had obscure pain or prolonged clinical symptoms with suspicious glomus tumors. Preoperative MRI might be one of the most useful tools for establishing the exact diagnosis and detecting the location of glomus tumors, in spite of the relatively high expenses.
Jeong, Hyun Keun;Jeong, Hyun Do;Nam, Ki Chang;Kim, Ho Chul
Journal of the Institute of Electronics and Information Engineers
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v.52
no.9
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pp.117-124
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2015
In this paper, we introduce how to control TR, TE physical MR parameters for managing $H_1$ spin's SI(Signal Intensity) which is combined with gadolinium following administration MR agent in T1 effect for diagnostic usefulness. we used MRI phantom made with 0.5 mol Gadoteridol. This phantom was scanned by FSE sequence with different TR, TE parameters. In this study, to make T1 effect, TR was 200, 250, 300, 350, 400, 450, 500, 550, 600 msec. In addition to, TE was 6.2, 12.4, 18.6, 21.6 msec. The results were as follows ; Each RSP(Reaction Starting Point) was 100, 50, 40, 30 mmol in TE 6.2, 12.4, 18.6, 21.6 msec being irrelevant to TR. In MPSI(Max Peak Signal Intensity), 4 mmol was showed in TR 200 msec while peak signal was decreased to low concentration mol in TR 250-600 msec. In terms of RA(Reaction Area), the highest SI was TE 6.2 msec in TR 200-600msec. According to the study, we are able to recognize it is possible to control enhance rates by managing TR and TE of MR parameters; moreover, we expect that enhanced T1 image in MR clinical field can be performed in a practical way with this quantitative data.
Jeong, Hyun Keun;Jeong, Hyun Do;Nam, Ki Chang;Jang, Geun Yeong;Kim, Ho Chul
Journal of the Institute of Electronics and Information Engineers
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v.52
no.12
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pp.134-141
/
2015
The purpose on this research is quantitatively comparing and analyzing signal intensity of 1.0mol and 0.5mol contrast agent. For this study, two MR phantoms were produced. One of them is used with 1.0mol Gadobutrol. The other is used with 0.5mol Gadoteridol. These two phantoms respectively have been scanned by SE T1 sequence which is used to get a general contrast-enhanced image in 1.5T MRI and 3D FLASH sequence which is used as enhanced angio MRI. Signal intensity was measured by scanned images as per contrast agent dilution ratio. The results were as follow: RSP(Reaction Starting Point) of the two sequences(2D SE, 3D FLASH) was respectively 6.0%, 60.0% in 0.5mol contrast and 2.0%, 20.0% in 1.0mol contrast, which means in 0.5mol contrast, RSP was formed faster than the one in 1.0mol contrast. MPSI was respectively 1358.8[a.u], 1573[a.u] in 0.5mol contrast and 1374[a.u], 1642.4[a.u] in 1.0mol contrast, which means 0.5mol contrast's MPP (0.4%, 10.0%) was formed faster than 1.0mol contrast's MPP (0.16%, 1.8%). Lastly, RA as per contrast agent dilution ratio was 27.4%, 11.8% wider in 0.5mol contrast(20747.4[a.u], 23204.6[a.u]) than in 1.0mol contrast(12691.9[a.u], 20747.4[a.u]). According to the study, we are able to assure that signal reaction time of 1.0mol contrast is slower than the one of 0.5mol contrast in contrast-enhanced MRI at two different sequences(2D SE, 3D FLASH). Furthermore, owing to the fact that there are not any signal intensity differences between 1.0mol and 0.5mol contrast, it is not true that high concentration gadolinium MR contrast agent does not always mean high signal intensity in MRI.
Yang, Dal Mo;Jahng, Geon-Ho;Kim, Hyun Cheol;Kim, Sang Won;Kim, Hyug-Gi
Investigative Magnetic Resonance Imaging
/
v.18
no.3
/
pp.208-218
/
2014
Purpose : To evaluate the relationship between the speed of enhancement of hepatic hemangiomas on gadolinium-enhanced MRI and ADC values by using various parameters, including the D, f, $D^*$ and $ADC_{fit}$ on intravoxel incoherent motion (IVIM) MR Imaging. Materials and Methods: The institutional review board approved this retrospective study. A total of 47 hepatic hemangiomas from 39 patients were included (20 men and 19 women). The hemangiomas were classified into three types according to the enhancement speed of the hepatic hemangiomas on gadolinium-enhanced dynamic T1-weighted images: rapid (Type A), intermediate (Type B), and slow (Type C) enhancement. The D, f, $D^*$ and $ADC_{fit}$ values were calculated using IVIM MR imaging. The diffusion/perfusion parameters and ADC values were compared among the three types of hemangiomas. Results: Both the $ADC_{fit}$ and D values of type C were significantly lower than those of type A (P = 0.0022, P = 0.0085). However, for the f and $D^*$, there were no significant differences among the three types. On DWI with all b values (50, 200, 500 and $800sec/mm^2$), the ADC values of type C were significantly lower than those of the type A (P < 0.012). For b values with $800sec/mm^2$, the $ADC_{800}$ values of the type C hemangiomas were significantly lower than those of type B (P = 0.0021). We found a negative correlation between hepatic hemangioma enhancement type and $ADC_{50}$ (${\rho}=-0.357$, P = 0.014), $ADC_{200}$ (${\rho}=-0.537$, P = 0.0001), $ADC_{500}$ (${\rho}=-0.614$, P = 0.0001), and $ADC_{800}$ (${\rho}=-0.607$, P = 0.0001). Therefore, four ADC values of $ADC_{50}$, $ADC_{200}$, $ADC_{500}$, and $ADC_{800}$ were decreased with decreasing enhancement speed. Conclusion: Hepatic hemangiomas had variable ADCs according to the type of enhancement, and the reduced ADCs in slowly enhancing hemangiomas may be related to the reduced pure molecular diffusion (D).
Yoo, Jin Young;Chun, Eun Ju;Kim, Yeo-Koon;Choi, Sang Il;Choi, Dong-Ju
Investigative Magnetic Resonance Imaging
/
v.18
no.1
/
pp.7-16
/
2014
Purpose : To evaluate the prevalence and pattern of perfusion defect (PD) on first-pass stress perfusion MR imaging in relation with the degree of left ventricular hypertrophy (LVH) and late gadolinium-enhancement (LGE) in patients with apical hypertrophic cardiomyopathy (APH). Materials and Methods: Cardiac MR imaging with first-pass stress perfusion, cine, and LGE sequence was performed in 26 patients with APH from January 2008 to December 2012. We analyzed a total of 416 segments for LV wall thickness on end-diastolic phase of cine images, and evaluated the number of hypertrophied segment and number of consecutive hypertrophied segment (NCH). We assessed the presence or absence of PD and LGE from all patients. If there was PD, we subdivided the pattern into sporadic (sporadic-PD) or ring (ring-PD). Using univariate logistic method, we obtained the independent predictor for presence of overall PD and ring-PD. Results: PD on stress perfusion MRI was observed in 20 patients (76.9%), 12 of them (60%) showed ring-PD. Maximal LV wall thickness and number of hypertrophied segment were independent predictors for overall PD (all, p < 0.05). NCH with more than 3 segments was an additional independent factor for ring-PD. However, LGE was not statistically related with PD in patients with APH. Conclusion: About three quarters of the patients with APH showed PD, most of them represented as ring-PD. LVH degree or distribution was related with pattern of PD, however, LGE was not related with PD. Therefore, the clinical significance of PD in the patients with APH seems to be different from those with non-APH, and further comparison study between the two groups should be carried out.
Many clinical and laboratory tests have been employed to evaluate disease activity in rheumatioid arthritis. $^{99m}Tc$-labelled polyclonal IgG(HIG) has been demonstrated to accumulate in focal sites of infection or inflammation in both animals and human subjects. The purpose of this study was to distinguish arthritis with active inflammation from those without active inflammation and to correlate relative intensities of $^{99m}Tc$-labelled HIG uptake of the rheumatoid arthritis with clinical and MR indices of the joint inflammation. This study included twelve patients with active rheumatoid arthritis, two with ankylosing spondylitis and one with degenerative osteoarthritis without active inflammation. A Whole-body and spot images were obtained 4 hours after intravenous injection of 20mCi of $^{99m}Tc$-labelled HIG. Scintigrams were assessed visually by 3 experienced radiologists, and graded as normal or mildly and markedly increased uptake within the joints, and the degree of uptake was compared with clinical and radiologic severity of synovial inflammation. MRI studies were done on the involved joints consisted of wrist(n = 11), knee(n = 2) and hip joint(n= 2). Active synovitis was defined when marked elevation of ESR and gadolinium enhancement of synovium on MRI were demonstrated. Markedly increased radiotracer uptake was seen in 10 of 11 rheumatoid arthritic patients with active synovitis whereas normal or mildly increased uptakes were noted in others, including rheumatoid arthritic patient(n=1) and non-rheumatoid patients(n = 3) without active synovitis. This study showed that the localization of involved joints in rheumatoid arthritis could be detected with $^{99m}Tc$-labelled HIG and that the degree of uptake correlated well with the degree and activity of inflammation. In conclusion, $^{99m}Tc$-labelled HIG scan is a useful method in the evaluation of active inflammation in rheumatoid arthritis.
For the purpose of finding new cathode materials for medium-temperature $(700\~800^{\circ}C)$ solid oxide fuel cells, $Gd_{0.8}Ca_{0.2}Co_{1-x}Fe_xO_3,\;(x=0.0\~0.5)$ are prepared, and their thermal stability and conductivity characteristics are investigated. Also, the cathodic activities are measured after the cathode layer being attached on CGO (cerium-gadolinium oxide) electrolyte disk. The X-ray analyses indicate that the materials prepared by calcining the citrate-gels at $800^{\circ}C$ have the orthorhombic perovskite structure without discernible impurities. The thermal stability of the undoped Co perovskite is so poor that it is decomposed to the individual binary oxide even at $1300^{\circ}C$. But the partially Fe-doped cobaltates exhibit a better thermal stability to retain their structural integrity up to $1400^{\circ}C$. The observation whereby both the undoped and Fe-doped cobaltates melt at ca. $1300^{\circ}C$ leads us to perform the electrode adhesion at <$1300^{\circ}C$. The cathodic activity of $Gd_{0.8}Ca_{0.2}Co_{1-x}Fe_xO_3,\;(x=0.0\~0.5)$, electrodes is superior to $La_{0.9}Sr_{0.1}MnO_3$, among the samples of $x=0.0\~0.5$, the x=0.2 cathode shows the best activity for the oxygen reduction reaction. It is likely that the Fe-doping provides a better thermal stability to the materials but in turn imparts an inferior cathodic activity, such that the optimum trade-off is made at x=0.2 between the two factors. The total electrical conductivity and ion conductivity of $Gd_{0.8}Ca_{0.2}Co_{1-x}Fe_xO_3$, are measured to be 51 S/cm and $6.0\times10^{-4}S/cm\;at\;800^{\circ}C$, respectively. The conductivity values illustrate that the materials are a mixed conductor and the reaction sites can be expanded to the overall electrode surface, thereby providing a better cathodic activity than $La_{0.9}Sr_{0.1}MnO_3$.
Kim, Sung-Hyun;Kim, Young-Bin;Jung, Suk-Hee;Kim, Min-Woo;Oh, Kyung-Min;Park, Ji-Gun
Journal of the Korean Society of Radiology
/
v.2
no.3
/
pp.11-18
/
2008
In this study, the particle properties and luminescence properties of Gd2O3 nano powder with various Eu content were studied. Gd2O3:Eu nano powder was fabricated using special solvent which mixed the alcohol and the distilled water at specific ratio. This solvent by the solution method showed short fabrication time because solution time of Gd and Eu was reduced. From this experiment with Gd2O3:Eu, the particle properties og nano powder phosphor way analysed using SEM (scanning electron microscope) and EDX(Energy Dispersive X-ray). Also the luminescence properties of nano powder was measured using PL(Photoluminescence) and CL (CathodeLuminescence). The size of powder was 30nm~40nm. The magnitude of powder showed the best peak at 620nm. Among 1,3,5wt% of Eu content, the more Eu content was added in powder, the more photons wre generated. Also it shows luminescence efficiency was improved adding 5% of Eu content.
The concentration of intracellular $Ca^{2+}$ was measured by spectrofluorometer after rat submandibular acinar cells were loaded with fura-2/AM(fura-2). After isoproterenol and octanol were administered while letting submandibular gland acinar cell placed in a perfusion chamber flow through a standard solution, the changes of $Ca^{2+}$ concentration were measured. When they were administered separately, there showed little changes of intracellular $Ca^{2+}$ concentration. When they were administered at the same time, however the concentration of intracellar $Ca^{2+}$ was shown to increase. When forskolin, an adenylate cyclase activater, was administerd together with octanol the response looked similar to the response of isoproterenol. In case of the extracellular $Ca^{2+}$ was removed by omitting $Ca^{2+}$ in standard solution and treating EGTA, isoproterenol and forskolin does not affect to the concentration of intracellular $Ca^{2+}$. Therefore, it was certified that the increase of intracellular $Ca^{2+}$ was caused from outside the cell. In order to know that the $Ca^{2+}$ influx is related with capacitative entry pathway, godolinium, blocker of that pathway was treated. With the result of that experiment there was no complete control of the increase in the concentration of intracellular $Ca^{2+}$. However, speed and amount of $Ca^{2+}$ increase was comparatively diminished.
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