• Progress in Medical Physics
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• v.24 no.2
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• pp.108-118
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• 2013

Currently, an arterial spin labeling (ASL) magnetic resonance imaging (MRI) technique does not routinely used in clinical studies to measure perfusion in brain because optimization of imaging protocol is required to obtain optimal perfusion signals. Therefore, the objective of this study was to investigate changes of perfusion-weighed signal intensities with varying several parameters on a pulsed arterial spin labeling MRI technique obtained from a 3T MRI system. We especially evaluated alternations of ASL-MRI signal intensities on special brain areas, including in brain tissues and lobes. The signal targeting with alternating radiofrequency (STAR) pulsed ASL method was scanned on five normal subjects (mean age: 36 years, range: 29~41 years) on a 3T MRI system. Four parameters were evaluated with varying: 1) the labeling gap, 2) the labeling delay time, 3) the labeling thickness, and 4) the slice scan order. Signal intensities were obtained from the perfusion-weighted imaging on the gray and white matters and brain lobes of the frontal, parietal, temporal, and occipital areas. The results of this study were summarized: 1) Perfusion-weighted signal intensities were decreased with increasing the labeling gap in the bilateral gray matter areas and were least affected on the parietal lobe, but most affected on the occipital lobe. 2) Perfusion-weighted signal intensities were decreased with increasing the labeling delay time until 400 ms, but increased up to 1,000 ms in the bilateral gray matter areas. 3) Perfusion-weighted signal intensities were increased with increasing the labeling thickness until 120 mm in both the gray and white matter. 4) Perfusion-weighted signal intensities were higher descending scans than asending scans in both the gray and white matter. We investigated changes of perfusion-weighted signal intensities with varying several parameters in the STAR ASL method. It should require having protocol optimization processing before applying in patients. It has limitations to apply the ASL method in the white matter on a 3T MRI system.

• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.912-919
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• 2020

Purpose This study aimed to compare the brain perfusion status of patients with chronic kidney disease to a normal control group to identify any significant differences. Materials and Methods The perfusion state of the brain was measured by MRI using the arterial spin labeling technique in 36 patients undergoing hemodialysis due to chronic kidney disease and 36 normal controls. Images were then analyzed in a voxel-wise manner to detect brain areas showing significant perfusion differences between the two groups. Results Patients with chronic kidney disease showed increased perfusion in the form of large clusters across the right fronto-parieto-temporal lobe and the left parieto-occipital lobe. In addition, perfusion increased in the bilateral thalami, midbrain, pons, and cerebellum (p < 0.01, familywise error corrected). Conclusion Brain perfusion appears to increase in patients with chronic kidney disease compared to normal controls. Uremic toxicity is thought to be the cause of this increase as it can cause damage to the microscopic blood vessels and their surrounding structures.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.185-190
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• 2011

Objective : To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods : The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results : Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion : EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

• Korean Journal of Radiology
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• v.2 no.1
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• pp.28-36
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• 2001

Objective: To provide a systematic overview of the effects of various parameters on contrast enhancement within the same population, an animal experiment as well as a computer-aided simulation study was performed. Materials and Methods: In an animal experiment, single-level dynamic CT through the liver was performed at 5-second intervals just after the injection of contrast medium for 3 minutes. Combinations of three different amounts (1, 2, 3 mL/kg), concentrations (150, 200, 300 mgI/mL), and injection rates (0.5, 1, 2 mL/sec) were used. The CT number of the aorta (A), portal vein (P) and liver (L) was measured in each image, and time-attenuation curves for A, P and L were thus obtained. The degree of maximum enhancement (Imax) and time to reach peak enhancement (Tmax) of A, P and L were determined, and times to equilibrium (Teq) were analyzed. In the computed-aided simulation model, a program based on the amount, flow, and diffusion coefficient of body fluid in various compartments of the human body was designed. The input variables were the concentrations, volumes and injection rates of the contrast media used. The program generated the time-attenuation curves of A, P and L, as well as liver-to-hepatocellular carcinoma (HCC) contrast curves. On each curve, we calculated and plotted the optimal temporal window (time period above the lower threshold, which in this experiment was 10 Hounsfield units), the total area under the curve above the lower threshold, and the area within the optimal range. Results: A. Animal Experiment: At a given concentration and injection rate, an increased volume of contrast medium led to increases in Imax A, P and L. In addition, Tmax A, P, L and Teq were prolonged in parallel with increases in injection time The time-attenuation curve shifted upward and to the right. For a given volume and injection rate, an increased concentration of contrast medium increased the degree of aortic, portal and hepatic enhancement, though Tmax A, P and L remained the same. The time-attenuation curve shifted upward. For a given volume and concentration of contrast medium, changes in the injection rate had a prominent effect on aortic enhancement, and that of the portal vein and hepatic parenchyma also showed some increase, though the effect was less prominent. A increased in the rate of contrast injection led to shifting of the time enhancement curve to the left and upward. B. Computer Simulation: At a faster injection rate, there was minimal change in the degree of hepatic attenuation, though the duration of the optimal temporal window decreased. The area between 10 and 30 HU was greatest when contrast media was delivered at a rate of 2 3 mL/sec. Although the total area under the curve increased in proportion to the injection rate, most of this increase was above the upper threshould and thus the temporal window was narrow and the optimal area decreased. Conclusion: Increases in volume, concentration and injection rate all resulted in improved arterial enhancement. If cost was disregarded, increasing the injection volume was the most reliable way of obtaining good quality enhancement. The optimal way of delivering a given amount of contrast medium can be calculated using a computer-based mathematical model.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.7
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• pp.4704-4710
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• 2015

The purpose of this study is to obtain a useful diagnostic image by increasing the signal strength of the peripheral artery, was to use a T1 shortening effect of gadolinium contrast agents to improve the disadvantages of the phase image. From october to december 2014 thirty patients were underwent the MRI scanning, except for heart disease. Research method was evaluated comparing the image after gadolinium contrast MR image acquisition step before evaluating the difference between the signal intensity for T1 shortening effect. In frontal lobe 19.45%, temporal lobe 23.09%, occipital lobe 25.45%, parietal lobe 18.82%, cerebellum 20.93% after peripheral arterial signal strength results of gadolinium contrast agent injection was increased significantly after injection of gadolinium both statistically significant. After injecting a contrast agent gadolinium in SWI by increasing the signal strength of the T1 shortening effect can be obtained when using the phase image to give a useful image in diagnosis and treatment.

• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1289-1295
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• 2000

Purpose : Recent evidence suggests a possible role for leukocytes in brain injury following ischemia and reperfusion. This study examined the temporal profile of ischemic tissue damage and leukocyte response after transient middle cerebral artery occlusion(MCAO) with reperfusion in the mouse. Methods : Focal cerebral ischemia was made by temporary occluding of the stem of the proximal MCA. Two groups of the mouse were investigated : (1) sham operation(n＝10), and (2)those having the arterial occlusion released after 90 minute(n＝20). By 4 hours(n＝10) and 24 hours(n＝10) after the onset of ischemia-reperfusion, fluorescein videoimages were under-taken in the pial venules of the mouse using a closed cranial window technique. Rhodamine 6G was administered as a $80-100{\mu}l/min$ i.v. loading dose and a $30-40{\mu}l/min$ i.v. maintenance dose in saline to selectively label circulating leukocytes. Neuropathologic evaluation for brain injury was accomplished using the histochemical stain 2,3,5-triphen-yltetrazolium chloride(TTC) and hematoxylin and eosin(H & E) stain. Results : The mean number of adherent leukocytes to cerebral venules in the 90 minutes MCAO and 24 hours reperfusion group were $306{\pm}24$ compared with $72{\pm}8$ in the sham operation group. In the TTC staining method, the cortical infarct affecting 34.8% of hemispheric volume were created in all of animals (n＝10) undergoing 90 minute MCAO with 24 hours reperfusion, but the infarcted area were not found in the other(sham operation and 90 minute MCAO with 4 hours reperfusion)groups. In the H & E stain, the brain tissue following 90 minute MCAO with 4 hours reperfusion revealed only a pyknosis of the nuclei with shrunken cytoplasm, but infiltrated leukocytes were not observed. After 24 hours of reperfusion, a many leukocytes were infiltrated within parenchyma and blood vessles. Conclusions : These findings demonstrate the feasiblity of continous in vivo monitoring of leukocyte adherence in cerebral venules and suggest that reperfusion induced leukocyte adherence to venular endothelium may contribute to tissue injury following focal cerebral ischemia.

• Journal of Korean Society for Atmospheric Environment
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• v.29 no.1
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• pp.10-26
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• 2013

To understand the traffic emissions with high temporal and spatial resolutions on road, a mobile laboratory was developed. The objective of this study is to characterize on-road air pollution on Naebu express way surrounding the northern area of Seoul, Korea. We measured the number concentration of ultrafine particles larger than 5 nm and particle size distribution using a condensation particle counter and a fast mobility particle sizer, respectively on 3, 7, and 8 December 2009. The average ultrafine particle number concentration on the Naebu express way excluding tunnels was 126,000 particles/$cm^3$ and 4.2 times higher than that on internal road at Korea Institute of Science and Technology in Seoul, and more than twice higher than that measured on and at the arterial roads of Seoul in previous studies. The maximum ultrafine particle number concentration was observed at the tunnel sections. It was 232,000 particles/$cm^3$ and 1.8 times higher than average ultrafine particle number concentration for the other sections on Naebu express way. The ultrafine particle number concentration on the wider roads with higher traffic volume along the Han River was similar to that in the residential section, probably because of enhanced dilution effect in widely open environment. The size distribution of particles on the Naebu express way was highly fluctuated for a short duration. Ultrafine particles measured at the tunnel showed a bimodal size distribution with mode diameters of ~10 nm and ~50 nm. At the Han riverside section, ~10 nm particles appeared significantly compared with size distribution at the tunnel. This on-road measurement approach can be utilized to manage vehicle-related air pollution in urban area.

• Korean Journal of Radiology
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• v.22 no.5
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• pp.725-734
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• 2021

Objective: To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). Materials and Methods: This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size (< 20 mm or ≥ 20 mm). Results: The frequency of portal venous phase (PP) washout with HBA-MRI was comparable to that of delayed phase (DP) washout with ECA-MRI (77.2% [88/114] vs. 68.4% [78/114]; p = 0.134). The frequencies were also comparable when IW was allowed (79.8% [91/114] for HBA-MRI vs. 81.6% [93/114] for ECA-MRI; p = 0.845). The sensitivities for HCC of LR-5 (using PP or DP washout) were comparable between HBA-MRI and ECA-MRI (78.1% [89/114] vs. 73.7% [84/114]; p = 0.458). In HCCs < 20 mm, the sensitivity of LR-5 was higher on HBA-MRI than on ECA-MRI (70.8% [34/48] vs. 50.0% [24/48]; p = 0.034). The sensitivity was similar to each other if IW was added to LR-5 (72.9% [35/48] for HBA-MRI vs. 70.8% [34/48] for ECA-MRI; p > 0.999). Conclusion: Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.8-16
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• 2008

Purpose: To assess the effect of extracranial-intracranial (EC-IC) bypass surgery on hemodynamic improvement, we evaluated serial regional cerebral hemodynamic change of the middle cerebral artery (MCA) in symptomatic patients with atherosclerotic occlusion of the internal carotid artery (ICA) or MCA using $^{99m}Tc$-ECD acetazolamide stress brain perfusion SPECT (Acetazolamide SPECT). Materials and Methods: The patients who had suffered a recent stroke with atherosclerotic ICA or MCA occlusion underwent EC-IC bypass surgery and Acetazolamide SPECT at 1 week before and three to six months after surgery. For image analysis, attenuation corrected images were spatially normalized to SPECT templates with SPM2. Anatomical automated labeling was applied to calculate mean counts of each Volume-Of-Interest (VOI). Seven VOIs of bilateral frontal, parietal, temporal regions of the MCA territory and the ipsilateral cerebellum were defined. Using mean counts of 7 VOIs, cerebral perfusion index and perfusion reserve index were calculated. Results: Seventeen patients (M:F =12:5, mean age $53{\pm}2yr$) were finally included in the analysis. The cerebral blood flow of the parietal region increased at 1 week (p = 0.003) and decreased to the preoperative level at 3-6 months (p = 0.003). The cerebrovascular reserve of the frontal and parietal regions increased significantly at 1 week after surgery (p<0.01) and improved further at 3-6 months. Conclusion: Cerebrovascular reserve of the MCA territory was significantly improved at early postoperative period after EC-IC bypass and kept improved state during long-term follow-up, although cerebral blood flow did not significantly improved. Therefore, cerebrovascular reserve may be a good indicator of postoperative hemodynamic improvement resulted from bypass effect.

• Radiation Oncology Journal
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• v.13 no.1
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• pp.9-18
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• 1995

Purpose : A retrospective analysis was performed to investigate the proper management of maxillary sinus carcinoma. Materials and Methods : Authors analysed 33 patients of squamous cell carcinoma of maxillary sinus treated at Chonnam University Hospital from January 1986 to December 1992. There were 24 men and 9 women with median age of 55 years. According to AJCC TNM system of 1988, a patient of T2, 10 patients of T3 and 22 patients of T4 were availalbe, respectively. Cervical lymph node metastases was observed in 5 patients(N 1;4/33, N2b; 1/33). Patients were classified as 3 groups according to management method. The first group, named as 'FAR' (16 patients), was consisted or preoperative intra-arterial chemotherapy with 5-fluorouracil(5-FU;mean of total dosage;3078mg) through the superficial temporal artery with concurrent radiation(mean dose delivered:3433cGy, daily 180-200cGy) and vitamin A(50,000 IU daily), and followed by total maxillectomy and postoperative radiation therapy(mean dose;2351cGy). The second group, named as 'SR'(7 patients), was consisted of total maxillectomy followed by postoperative radiation therapy(mean dose 5920 cGy). The third group, named as 'R'(6 patients), was treated with radiation alone(mean dose;7164cGy). Kaplan-Meier product limit method was used for survival analysis and Mantel-Cox test was performed for significance of survival difference between two groups. Results : Local recurrence free survival rate in the end of 2 year was $100\%$, $50\%$ and $0\%$ in FAR, SR and R group, respectively. Disease free survival rate in 2 years was $88.9\%$, $28.0\%$ and $0\%$ in FAR, SR and R group, respectively. Overall survival rate in 2 years was $88.9\%$, $40\%$ and $50\%$ in FAR, SR and R group, respectively. There were statistically significant difference between FAR and SR or FAR and R group in their local recurrence free, disease free and overall survial rates. But difference of each survival rate between SR and R group was not significant. Conclusion : In this study FAR group revealed better results than SR or R group. In the future prospective randomized study is in need.