• Journal of Chest Surgery
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• 제44권3호
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• pp.247-249
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• 2011

We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due to infective endocarditis with bovine pericardium 4 years prior. Echocardiography and computed tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.

• 한국의학물리학회지:의학물리
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• 제22권1호
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• pp.42-51
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• 2011

전통적으로 심근 생존능을 식별하고 심근 관류를 정확히 평가하기 위한 도구로 핵의학영상이 이용되고 있으나 경색영역을 정의하기에는 어려움이 있다. 이에 본 연구에서는 극성지도의 분포를 분석하여 특성에 맞는 적응적 임계값을 이용하여 심근경색 모델을 정량적으로 평가하고자 하였다. 쥐 심근경색 모델은 왼쪽 관상동맥을 결찰시켜 제작하였다. 소동물PET 영상은 37 MBq $^{18}F$-FDG를 쥐의 꼬리정맥에 주사한 후 60분 섭취 후 Siemens Inveon SPECT/PET 스캐너를 이용하여 20분 동안 ECG 신호와 함께 획득하였고, OSEM 2D 알고리즘을 이용하여 재구성하였다. PET 영상의 심근 극성지도는 Siemens QGS 소프트웨어에 적합한 형식으로 변환 후 자동으로 심근 벽을 설정하여 작성하였다. 심근경색영역의 기준데이터는 TTC 염색으로 설정하였으며 전체 좌심실대비 염색된 영역의 백분율로 획득하였다. 최적의 임계값 설정을 위해 절대치 설정 방법, Otsu 알고리즘, 다중가우시안혼합모델(Multi Gaussian mixture model, MGMM)을 이용하여 평가하였다. 절대치 설정 방법은 10~90%까지 10%단위로 미리 정의 된 임계값을 이용하였고, Otsu 알고리즘은 영상 내에서 두 군집의 분산을 최대로 하는 임계값으로 설정하였다. MGMM 방법은 영상의 화소 강도를 분석하여 여러 개의 가우시안 분포함수(MGMM2, $\cdots$ MGMM4)로 반복 수행하여 최적의 가우시안 분포를 구하여 적응적 임계값을 설정하였다. 극성지도 평가지표는 각각의 알고리즘에서 측정된 임계값을 이용하여 이진화하고 전체 극성지도와 경색영역의 백분율로 획득한 후, TTC 염색으로 획득된 기준데이터와의 차이를 비교하였다. 그 차이는 절대치 방법의 20%에서 $7.04{\pm}3.44%$, 30%에서 $3.87{\pm}2.09%$, 40%에서 $2.15{\pm}2.07%$이었다. Otsu 방법은 $3.56{\pm}4.16%$이었으며 MGMM 방법은 $2.29{\pm}1.94%$이었다. 소동물 PET 극성지도에서는 30% 임계값이 조직학적 데이터와 비교하여 가장 작은 차이를 보였다. 그러나 TTC 염색으로 측정한 크기가 10% 이하에서는 MGMM 방법이 절대치 방법보다 작은 차이를 보였다(MGMM: 0.006%, 절대치방법: 0.59%). 이 연구에서는 심근경색 모델 평가를 위하여 생체영상 극성지도에서 다중가우시안혼합모델을 이용하여 평가하고자 하였다. MGMM은 사용자의 선택 없이도 자동적으로 영상 특성을 고려하여 적응적 임계값을 찾아주는 방법으로 극성지도에서 심근경색을 평가하는데 도움이 될 것으로 기대된다.

• Korean Journal of Radiology
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• 제22권10호
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• pp.1597-1608
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• 2021

Cardiovascular computed tomography (CT) is among the most active fields with ongoing technical innovation related to image acquisition and analysis. Artificial intelligence can be incorporated into various clinical applications of cardiovascular CT, including imaging of the heart valves and coronary arteries, as well as imaging to evaluate myocardial function and congenital heart disease. This review summarizes the latest research on the application of deep learning to cardiovascular CT. The areas covered range from image quality improvement to automatic analysis of CT images, including methods such as calcium scoring, image segmentation, and coronary artery evaluation.

• 대한핵의학회지
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• 제34권3호
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• pp.228-233
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• 2000

목적: 역재분포(reverse redistribution)는 심근관류영상에서 초기 thallium 섭취가 정상이거나 정상에 가까운 지역이 재분포 영상에서는 결손으로 보이는 것으로 정의되는데 역재분포의 특성을 더욱 잘 이해하기 위하여 심근조영 심초음파(myocardial contrast echocardiography, MCE)에 의해 진단된 심내막하심근경색과 심근 SPECT 영상에서 관찰되는 역재분포를 연관시켜 분석하였다. 대상및 방법: 급성심근경색으로 진단된 20명의 환자들을 대상으로 경피적 관동맥 성형술로 재혈관화 한 후에 심근조영 심초음파를 시행 한 후 24시간 이내에 심근 SPECT를 시행하였다. 심근조영 심초음파로 미세혈관분포에 대한 조영증강 정도를 세 단계로 평가하였고(1: 정상 조영증강, 0.5: 부분 조영증강, 0: 조영증강 없음) 심내막하경색의 진단은 심외막에만 국한되어 조영이 되고 심내막이 조영되지 않을 경우로 하였다. 심근관류 결손은 4단계(경도, 중등도, 고도, 정상)로 나누었고 24시간 지연영상에서 1단계 이상 나빠지는 경우 역재분포가 존재한다고 판단하였다. 비모수적 Kendall 상관 계수를 SAS 통계 패키지를 이용하여 계산하였다. 결과: 20예 중 15예(75%)가 일치하였다(8예는 양쪽 검사 모두에서 양성, 7예는 음성). 통계 분석상 심근조영심초음파 양성(심내막하 심근경색)인 예와 SPECT 양성(역재분포인 예)인 예의 사이에는 Kendall 상관계수가 0.5025였고 P값이 0.0285였다. 결론: 급성심근경색 환자에서 재혈관화치료 후에 관찰되는 역재분포 소견은 심근조영 심초음파에 보이는 심내막하 심근경색 소견과 유의한 연관이 있었다.

• Nuclear Medicine and Molecular Imaging
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• 제43권3호
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• pp.229-239
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• 2009

Molecular imaging strives to visualize processes in living subjects at the molecular level. Monitoring biochemical processes at this level will allow us to directly track biological processes and signaling events that lead to pathophysiological abnormalities, and help make personalized medicine a reality by allowing evaluation of therapeutic efficacies on an individual basis. Although most molecular imaging techniques emerged from the field of oncology, they have now gradually gained acceptance by the cardiovascular community. Hence, the availability of dedicated high-resolution small animal imaging systems and specific targeting imaging probes is now enhancing our understanding of cardiovascular diseases and expediting the development of newer therapies. Examples include imaging approaches to evaluate and track the progress of recent genetic and cellular therapies for treatment of myocardial ischemia. Other areas include in vivo monitoring of such key molecular processes as angiogenesis and apoptosis, Cardiovascular molecular imaging is already an important research tool in preclinical experiments. The challenge that lies ahead is to implement these techniques into the clinics so that they may help fulfill the promise of molecular therapies and personalized medicine, as well as to resolve disappointments and controversies surrounding the field.

• Korean Journal of Radiology
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• 제21권4호
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• pp.462-470
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• 2020

Objective: To demonstrate that human visual illusion can contribute to sub-endocardial dark rim artifact in contrast-enhanced myocardial perfusion magnetic resonance images. Materials and Methods: Numerical phantoms were generated to simulate the first-passage of contrast agent in the heart, and rendered in conventional gray scale as well as in color scale with reduced luminance variation. Cardiac perfusion images were acquired from two healthy volunteers, and were displayed by the same gray and color scales used in the numerical study. Before and after k-space windowing, the left ventricle (LV)-myocardium boarders were analyzed visually and quantitatively through intensity profiles perpendicular the boarders. Results: k-space windowing yielded monotonically decreasing signal intensity near the LV-myocardium boarder in the phantom images, as confirmed by negative finite difference values near the board ranging -1.07 to -0.14. However, the dark band still appears, which is perceived by visual illusion. Dark rim is perceived in the in-vivo images after k-space windowing that removed the quantitative signal dip, suggesting that the perceived dark rim is a visual illusion. The perceived dark rim is stronger at peak LV enhancement than the peak myocardial enhancement, due to the larger intensity difference between LV and myocardium. In both numerical phantom and in-vivo images, the illusory dark band is not visible in the color map due to reduced luminance variation. Conclusion: Visual illusion is another potential cause of dark rim artifact in contrast-enhanced myocardial perfusion MRI as demonstrated by illusory rim perceived in the absence of quantitative intensity undershoot.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 1999년도 Japanese Journal of Medical Physics
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• pp.128-128
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• 1999

• Journal of Cardiovascular Imaging
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• 제31권4호
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• pp.191-199
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• 2023

BACKGROUND: Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS: We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS: A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS: Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.

• 대한방사성의약품학회지
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• 제4권2호
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• pp.57-64
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• 2018

${\omega}-[^{18}F]$-Fluorohexadecanoic acid (FHA) has been used for imaging of fatty acid metabolism of myocardium. To increase retention of radiolabeled fatty acid by blocking ${\beta}$-oxidation, methyl branched analogues have been used. In this experiment, we tried to synthesize 18F-labeled ${\alpha}-$, ${\beta}-$ and ${\omega}-FHA$ for imaging of the myocardial fatty acid metabolism. We synthesized ${\alpha}-$, ${\beta}-$ and ${\omega}$-mesylated methyl hexadecanoates and labeled with $^{18}F$ by reacting with $[^{18}F]$TBAF in acetonitrile at $80^{\circ}C$ for 10 min. Methyl ester group was removed by 1 M NaOH at $80^{\circ}C$ for 5 min. The yields of ${\alpha}-[^{18}F]$ and ${\omega}-[^{18}F]FHA$ were 25.5 and 45.5%, respectively [EOS]. However, ${\beta}-[^{18}F]FHA$ was not labeled at all due to a fast elimination reaction. The biodistribution study in ICR-mice showed that ${\omega}-[^{18}F]FHA$ has higher myocardial uptake and lower liver uptake than ${\alpha}-[^{18}F]FHA$. The electron-withdrawing effect of fluorine at ${\alpha}-$ position is believed to be the major factor affecting the biodistribution.

• 대한핵의학회지
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• 제39권2호
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• pp.94-99
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• 2005

Electrocardiogram-gated single photon omission computed tomography (SPECT) provides valuable information in the assessment of both myocardial perfusion and ventricular function. Tl-201 is a suboptimal isotope for gating. Tl-201 images are more blurred compared with Tc-99m tracers due to the increased amount of scattered photons and use of a smooth filter. The average myocardial count densities are approximately one-half those of conventional technetium tracers. However, Tl-201 is still widely used because of its well-established utility for assessing myocardial perfusion, viability and risk stratification. Gated SPECT with Tl-201 enables us to assess both post-stress and rest left ventricular volume and function. Previous studies with gated Tl-201 SPECT measurements of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) have shown high correlation with first-pass radionuclide angiography, gated blood pool scan, Tc-99m-MIBI gated SPECT, contrast ventriculography, echocardiography, and 3-dimensional magnetic resonance imaging. However, problems related to these studies include few agreement data of EDV and ESV, use of a reference method that is likely to have the same systemic errors (gated Tc-99m-MIBI SPECT), and other technical factors related to the count density of gated SPECT. With optimization of gated imaging protocols and more validation studies, gated Tl-201 SPECT would be an accurate method to provide perfusion and function information in patients with coronary artery disease.