뇌 동맥류 진단에 있어 디지털 감산 혈관조영술과 다중검출기 전산화단층촬영 혈관조영술의 유용성 비교

강현수,서선열,한동균,권수일,심수정,조삼주,Khang, Hyun-Soo,Seo, Sun-Youl,Han, Dong-Kyoon,Kwon, Soo-Il,Shim, Su-Jung,Cho, Sam-Ju 한국의학물리학회 2011 의학물리 Vol.22 No.4

본 연구는 뇌동맥류로 진단받은 환자 중 디지털 감산 혈관조영술(DSA)과 다중검출기 전산화단층촬영 혈관조영술(MDCT Angiography)의 영상을 비교하여 MDCT 혈관조영술에 대한 뇌동맥류의 선별검사로써 그 유영성을 평가하고자 하였다. 이를 위해 대학병원에서 DSA을 시행한 후 뇌동맥류로 진단 받은 환자 중 MDCT 혈관조영술을 함께 시행한 194명의 환자를 대상으로 DSA과 MDCT 혈관조영 장치의 영상에서 뇌동맥류의 유무를 분석하였고, 동맥류의 길이를 경부의 크기로 나누어 1보다 크면 경부가 좁은 협경 동맥류, 1보다 작으면 경부가 넓은 광경 동맥류로 분류하여 협경, 혹은 광경 동맥류인지 비교 분석하였다. 본 연구 결과 DSA과 비교한 MDCT 혈관조영술의 뇌동맥류에 대한 민감도는 97.4%로 분석되었고, 협경 혹은 광경 동맥류의 일치도는 90.2%, MDCT 혈관조영술에서 뇌동맥류를 발견하지 못한 경우가 2.5%로 경부의 평균 크기는 2.4 mm였다. 이를 통해 뇌동맥류 선별검사를 위하여 비침습적인 MDCT 혈관조영술은 침습적인 DSA에 비하여 높은 민감도를 보여 매우 유용한 검사로 기대된다. The purpose of this study was to compare the image between DSA and MDCT Angiography and to examine whether MDCT Angiography could be useful as a screening test for the diagnosis of cerebral aneurysm in patients who were diagnosed with cerebral aneurysm on DSA. Of patients who were diagnosed with cerebral aneurysm DSA at University Hospital, 194 patients who concomitantly underwent MDCT Angiography were enrolled in the current retrospective study. The methods for analyzing cerebral aneurysm were to analyze the presence of cerebral aneurysm on DSA and MDCT Angiography. In cases in which it exceeded 1, the corresponding cases were classified as narrow-neck aneurysms. In otherwise cases, they were classified as wide-neck aneurysms. Thus, a comparative analysis could be performed to ascertain if cases were narrow-neck or wide-neck aneurysms. As compared with DSA, the sensitivity of MDCT Angiography for cerebral aneurysm was measured to be 97.4%. The degree of consistency between narrow-neck and wide-neck aneurysms was 90.2% and the proportion of undetectable an at MDCT Angiography was 2.54%. mean size was 2.4 mm. It is expected that a non-invasive diagnostic modality for a screening test for cerebral aneurysm, MDCT Angiography might be a very useful regimen as compared with an invasive one, DSA.

3.0T 자기공명영상장치를 이용한 사람의 간지럼자극과 감각중추 자극의 활성화 차이

강현수(Hyun-Soo Khang),임기선(Ki-Seon Lim),한동균(Dong-Kyoon Han) 한국콘텐츠학회 2010 한국콘텐츠학회논문지 Vol.10 No.2

기능적 자기공명영상법(fMRI)을 이용하여 일반 감각 자극과 다른 간지럼 자극 과제를 수행 할 때 대뇌 감각중추 신경 연결망을 규명하고, 간지럼이 웃음의 기전과 어떤 차이가 있는지를 알아보고자 하였다. 건강한 성인 남녀 16명(평균 : 28.9세)을 대상으로 두 종류의 감각 자극 과제 수행동안 3.0T 자기공명영상장치를 사용하여 기능적 자기공명영상을 얻었다. 감각 자극은 피험자마다 역균형화하여 제시되었으며, 블록 설계로 자극 제시와 영상 획득이 이루어졌다. 획득된 영상 데이터는 SPM 99 분석하였으며, 개별 분석과 그룹 분석을 실시하였다. 개별 분석 결과 두 과제 모두 체감각 영역의 활성화가 관찰되었고, 간지럼 자극 조건은 감각자극 조건에 비해 베리니케 영역(BA40)에서 더 많은 활성화를 보였다. 또한, 그룹 분석결과 일반 감각 조건에서는 양쪽 체감각 피질 영역(BA 1,2,3)이 활성화되었으며, 간지럼 조건에서는 양쪽 체감각 피질 뿐만 아니라 시상, 대상회, 대뇌섬엽 영역에서 커다란 활성화를 보였다. 간지럼 자극에서 감각자극을 뺀 결과에서는 우측 대상회와 좌측 MFG 영역 및 좌측섬엽 에서 유의미한 활성화를 보였다. 촉각을 통한 간지럼자극을 인지하는 대뇌영역에 대해 검증하였고, 간지럼과 같은 가장 원초적인 자극이 다양한 사회적 활동에서 중요한 기능을 담당하는 웃음과 밀접한 관련이 있음을 알 수 있었다. This study was performed to identify the cerebral network associated with sensation through the tickling stimulation, which is distinctive from the rest of other networks processing normal stimulation and to investigate the difference of laughing mechanism which is closely related to tickling using functional MRI(fMRI). A 16 healthy volunteers (mean age: 28.9) on a 3.0T MR scanner during two sensation conditions. Counterbalanced stimulus were presented across the participants, and the stimulation was used block design. Acquired data was analyzed by the statistical parametric mapping (SPM 99). Subject and group analysis was performed. Individual analysis showed the activation of somatic sensation area in both tasks and the tickling sensation test showed more activated area in the Wernicke's area(BA40) compared to the normal sensation. The group analysis result shows that under normal stimulations, both sides of somatosensory cortices(BA 1,2 and 3) were activated and under tickling stimulation, not only the cortices but also those huge activation on thalamus, cingulate gyrus and insular lobe were detected. When the tickling was stopped, significant activations were shown in right cingulate gyrus, left MFG area and left insular lobe. A cerebral area responsible for recognizing tickling sensation was examined and the primitive stimulation such as tickling is much closely related to laugh, which is an important factor for various social activities.

뇌교종의 악성도 평가에서의 관류자기공명영상의 유용성에 관한 연구

강현수(Hyun-Soo Khang),김종만(Jong-Man Kim),고신관(Shin-Kwan Ko),문찬홍(Chan-Hong Moon),유인규(In-Kye Yu),한동균(Dong-Kyoon Han) 대한방사선과학회(구 대한방사선기술학회) 2009 방사선기술과학 Vol.32 No.4

최근 신경계 질환의 진단에 많이 이용되는 자기공명영상기법 중 상대적 뇌 혈류량(relative cerebral blood volume)의 분석에 의한 뇌교종의 악성도 구분(고등급과 저등급 종양의 구분)에 있어 자기공명영상의 뇌 혈류량 검사의 유용성에 대하여 알아보고자 하였다. 뇌교종 환자 17명(평균연령 57.5세, 남자 11명, 여자 6명)을 대상으로 모든 환자에게 수술 전 관류자기공명영상과 고식적 뇌 자기공명영상을 시행하고, 조직의 병리학적 검사를 시행하였다. 국소적 뇌 혈류량과 상대적 뇌 혈류량의 분석은 지멘스사의 소프트웨어(PAT)와 자체 개발한 영상 후 처리 소프트웨어 Xmap 2.0을 이용하여 비교, 분석하였다. 대상자 17명 중 뇌교종이 저등급인 6명과 고등급인 11명의 관류자기공명영상의 분석 결과는 저등급 뇌교종의 상대적 뇌 혈류량의 백질에 대한 종양부위의 평균 뇌 혈류량(rCBVw)의 평균은 1.62, 피질에 대한 종양부위의 평균 뇌 혈류량(rCBVc)의 평균은 0.12이었다. 고등급 뇌교종의 상대적 뇌 혈류량의 rCBVw의 평균은 33.53, rCBVc의 평균은 0.96이었다. 뇌교종과 반대측 뇌 백질과의 통계적인 상관성은 0.01(p-value)이었고. 뇌교종과 반대측 피질과의 통계적인 상관성은 0.02(p-value)로 나타났다. 결과 중 뇌교종과 뇌 백질의 통계분석수치가 뇌교종과 피질과의 통계분석 결과보다 더 유의한 결과를 나타내었다. 결국 두 가지 모두에서 유의한 결과를 나타냄을 알 수 있었다(p To predict the tumor grading, various imaging modalities have been applied clinically. This study determines clinical usefulness of perfusion MRI, using relative cerebral blood volume in grading of the gliomas. We did a retrospective review of 17 patients (mean age, 57.5 years; 11 male, 6 female) who underwent perfusion MR and conventional MRI, and then correlated pathologically after operation. Statistical analysis of regional cerebral blood volume and relative cerebral blood volume(rCBV) was performed by using softwares such as PAT by SIEMENS and Xmap ver2.0 developed by ourselves. Six patients out of 13 were low-grade gliomas while eleven patients were the high-grade gliomas. Mean relative CBV(m_rCBV/white matter) in the low-grade gliomas was 1.62, and mean relative CBV(m_rCBV/cortex). Perfusion MRI using regional cerebral blood bolume and rCBV is very imaging modality for grading the glioma.

갑상선암 수술 전 진단목적의 $^{18}F$-FDG PET/CT Dual Time Point영상에서 SUV값과 방사능 농도 측정법의 유용성 평가

이현국,강현수,양승오,한만석,Lee, Hyun-Kuk,Khang, Hyun Soo,Yang, Seoung-Oh,Han, Man-Seok 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.2

Purpose : This study is designed to compare two parameters reflecting $^{18}F$-FDG uptake, SUV and radioactivity, for diagnosis of thyroid cancer in dual time $^{18}F$-FDG PET/CT imaging and to find which parameter is more useful to decide whether the tumor is malignant or not. Materials and Methods : We performed retrospective study for 40 patients. All patients are diagnosed as primary thyroid cancer and examined $^{18}F$-FDG PET/CT. First, we got the dispersion of scattering beam of neck and lung apex to set a background and compared each dispersion, mean value, standard deviation of maxSUV and radioactivity. Also, mean maxSUV, ${\Delta}maxSUV$, ${\Delta}maxBq$/ml(%) and radioactivity between groups according to lesion's size based on biopsy are compared with independent-sample t-test. Results : the values that were from maxSUV and radioactivity measurement technique were compensated and calculated to practical values for mean comparison and patients were divided to two groups based on tumor size, Group1 ($size{\leq}1$ cm, n=21), Group2 (size>1 cm, n=19) for accurate comparison. In Group1, maxSUV (semi-quantitative analysis) was increased from $5.64{\pm}5.85$ (1.89~17.84) at first image to $5.90{\pm}5.01$ (1.95~18.22) at second image and radioactivity (Bq/ml) (quantitative analysis) showed similar increase from $5.93{\pm}6.38$ (2.50~16.75) at first image to $6.01{\pm}5.25$ (2.66~16.58) at second image. In Group2, TFmaxSUV was $10.54{\pm}14.36$ (2.54~33.89) in true first image, TSmaxSUV was $9.85{\pm}12.88$ (2.62~26.20) in true second image separately. The maxSUV showed a significant difference in the mean comparison between the two groups (p=0.035) But, mean radioactivity (Bq/ml) was $5.93{\pm}6.38$ (4.81~40.99) in true first image, $6.01{\pm}5.25$ (4.51~36.93) in true second image and didn't show a significant difference statistically (p=0.126) Conclusion : In diagnosis of thyroid tumor, SUV and radioactivity depending on $^{18}F$-FDG uptake showed high similarity with coefficient of determination (R2=0.939) and malignant evaluation results using dual time also showed similar aspect. Radioactivity for evaluation of malignant tumor didn't show better specificity or sensitivity than maxSUV.

주의력결핍 과잉행동장애 아동에서 틱 장애 동반 여부에 따른 확산 텐서 영상 비교 연구

최지욱,임명호,이창화,박진균,손정우,심세훈,유인규,강현수,정범석 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.5

Objectives : Diffuse tensor imaging (DTI) was applied to explore the difference in regional distribution and extent of white matter (WM) abnormalities in boys with Attention-deficit/hyperactivity disorder (ADHD) versus boys with comorbid ADHD and tic disorders. Methods : Fifteen boys with ADHD (mean age 9.3 +1.8), 24 ADHD boys with chronic tic disorder or Tourette's disorder(9.9 =b 1.2) and 9 age-, gender-matched controls (9.2 d= 1.8) received DTI assessments. Fractional Anisotropy (FA) maps of WM were compared between groups with a voxel-wise analysis after intersubject registration to MNI space. Results : Bo groups, ADHD group and ADHD with tic disorder group, commonly showed decreased FA than healthy control group in left cerebellar middle peduncle and right frontal lobe, increased FA in right middle occipital WM. In the common areas of left cerebellar middle peduncle and right middle occipital WM, comorbid group showed broader areas of significant FA. The comorbid group also showed increased FA in right cerebellar peduncle, additionally. Conclusion : The findings in ADHD group support previous ADHD hypothesis of the functional abnormalities in corticocerebellar circuit, and suggest that ADHD might have more complicated pathology of neuronal circuit including occipital visual system. The comorbid group showed common areas of overlapping but more extensive abnormalities and also had additional WM abnormalities. ADHD with chronic tic disorders may represent a severe form of ADHD with additional regions of abnormal connectivity.