두통 환자에서 뇌자기공명영상의 유용성

전인석,김철환,이언숙,서홍관,이기재 인제대학교 1999 仁濟醫學 Vol.20 No.1S

연구배경; 두통은 가장 일반적인 증상이지만 많은 경우에서 사람을 무능력 하게 한다. 무엇보다 두통이 심하거나 오래 계속될 경우 뇌종양에 대한 공포가 있다. 임상 의사들도 최근 의료 사고 및 의료 분쟁의 증가로 인해 방어 진료를 하고 있다. 이런 이유에서 최근 고가 장비인 뇌자기공명영상을 두통 환자에서 시행하는 일이 많아지고 있다. 이 연구는 두통을 호소하는 환자에게서 신경학적 징후가 없을때, 뇌자기공명영상이 유용성이 있는 지를 알아보기 위한 연구이다. 방법; 1993년 1월 1일부터 1997년 3월 31일까지 서울백병원과 상계백병원 신경과, 신경외과, 소아과, 가정의학과 외래에 두통을 주소로 내원하여, 뇌자기공명영상을 시행한 환자 중에서, 임상 병록지를 검토하여 외상. 국소적 신경 증상 및 징후를 나타내거나 의식 소실이 있었던 경우, 과거력상 뇌혈관 사고의 병력이 있었던 경우를 제외시킨 123명을 대상으로 성별, 연령, 병력, 동반 증상, 두통의 이환 기간, 지자기 공명영상 소견을 조사하였다. 결과; 연구 대상은 남자 40명(32.5%), 여자 83명(675%)으로 총 123명이었다 환자의 연령은 7세에서 70세였으며, 평균 연령은 41.8세였다. 40대가 36명(29.3%), 30대가 29명(23.6%)이었다. 환자들의 병력은 고혈압이 10예(8.1%)로 가장 많았고 특별한 질병이 기재되어 있지 않은 경우가 107예(87.1%)였다. 두통과 연관된 뇌자기공명영상 이상 소견 14예 중에 동반질환이 있었던 예는 모두 5예(4.0%)였으며 상관 관계에는 유의성이 있었다(P<0.05). 두통과 동반한 증상은 오심 25예(20.3%), 어지러움 11예(8.9%) 구토 9예(7.3%) 안구통 7예(5.7%)였다. 두통과 동반한 증상과 뇌자기공명영상 이상 소견과의 상관 관계에는 유의성이 없었다(P>0.05). 두통의 이환 기간은 12개월에서 60개월이 37예(30.0%)로 가장 많았고, 1개월에서 11개월이 28예(22.8%), 60개월 이상이 27예(22.0%), 1개월 미만이 22예(17.9%)의 순이었다. 두통의 평균 이환 기간은 4년 2개월이었다. 두통 이환 기간과 뇌자기공명영상 이상 소견과의 상관관계에는 유의성이 없었다(P>0.05). 뇌자기공명영상 소견은 총 123예 중 정상 소견이 96예(78.0%), 이상 소견이 27예(22.0%)였으며, 이상 소견 중에 두통과 관련이 있는 소견은 14예(11.4%)로, 열공경색증(lacunar infarction) 8예(6.5%), 뇌허혈(cerebral ischemia) 3예(2.4%), 뇌수막종(meningioma) 2예(1.6%), 거미막낭종(arachnoid cyst) 1예(0.8%), 투명중격낭(cyst of septum pellucidum) 1예(0.8%)이며, 두통과 관련이 없는 이상 소견은, 뇌위축(cerebral atrophy) 3예(2.4%), 송과체낭종(pineal cyst) 1예(0.8%), mega cisterna magna 1예 (0.8%)였다. 결론; 본 연구에서 두통과 임상적으로 의미있는 뇌자기공명영상 소견은 두통 환자 123명 중에 14예(11.4%)였다. 따라서 두통 환자에서 적극적인 병력 청취와 이학적 검사를 실시하되, 충분한 기간 적절한 치료에도 반응이 없는 두통 환자는 뇌자기공명영상 촬영 등의 검사를 고려해야겠다. Background: Headache is a common symptom. but for many it can be a debilitating problem. The patients with headache tend to worry excessively about the possibility of cerebral tumor as the cause when it is severe and longstanding. Clinicians have protective attitude towards the management of headache because medical law suits have increased recently. For this reason, expensive Brain Magnetic Resonance Imaging has been used more often in the evaluation of headache patients recently. So we studied the usefulness of Brain Magnetic Resonance Imaging in the management of patients with headache who were neurologically normal. Methods: From January 1, 1993 to March 31, 1997, 123 patients with headache who had visited the department of neurology, neurosurgery, pediatric, and family medicine in Seoul and Sanggye Paik Hospital and had undergone Brain Magnetic Resonance Imagings. We reviewed the charts and selected the patients who had no prior histories of trauma, focal neurologic symptoms and signs, loss of consciousness, and cerebrovascular accidents. We checked their age, sex, past medical history, duration of headache, and Brain Magnetic Resonance Imaging findings. Results: There were total of 123 patients with headache. Subjects were 40 males(32.5%) and 83 females(67.5%). Male-to-female ratio was 1:2.1. The age ranged from 7 to 80 years with an average of 41.8 years. Thirty six patients(29.3%) were in their forties, 29(23.6%) in their thirties. Ten patients(8.1%) had histories of hypertension. Five of 10 patients(4.1%) with pastmedical disease were related with abnormal Brain Magnetic Resonance Imagings(P<0.05). The symptoms accompanying headache in order of frequency were nausea 25(20.3%), dizziness 11(8.9%), vomiting 9(7.3%), and eye pain 7(5.7%), Associated symptoms with headache did not correlate with abnormal Brain Magnetic Resonance Imagings(P>0.05) The duration of headache was 12 to 60 months in 37 patients(30.0%) , 1 to 11 months in 28(22.8%), above 60 months in 27(22.0%), and below 1 month in 22(17.9%), with an average duration of 4 years and 2 months. The duration of headache did not correlate with abnormal Brain Magnetic Resonance Imagings(P>0.05). Brain Magnetic Resonance Imaging findings were normal in 96 patients(78.0%). abnormal in 27(22.0%) headache relaxed findings in 14(11.4%) ; lacunar infarction in 8(6.5%), cerebral ischemia in 3(2.4), meningioma in 2(1.6%), arachnoid cyst in 1 (0.8%), and cyst of septum pellucidum in 1 (0.8%). Conclusions: There were clinically meaningful findings in Brain Magnetic Resonance Imaging in 14(11.4%) among 123 patients with headache. Primary care physician should take history and perform physical examination intensively, but consider Brain Magnetic Resonance Imaging if headache does not resolve by proper management.

Modern Brain Tumor Imaging

( Marc C. Mabray ),( Ramon F. Barajas Jr ),( Soonmee Cha ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2015 Brain Tumor Research and Treatment Vol.3 No.1

The imaging and clinical management of patients with brain tumor continue to evolve over time and now heavily rely on physiologic imaging in addition to high-resolution structural imaging. Imaging remains a powerful noninvasive tool to positively impact the management of patients with brain tumor. This article provides an overview of the current state-of-the art clinical brain tumor imaging. In this review, we discuss general magnetic resonance (MR) imaging methods and their application to the diagnosis of, treatment planning and navigation, and disease monitoring in patients with brain tumor. We review the strengths, limitations, and pitfalls of structural imaging, diffusion-weighted imaging techniques, MR spectroscopy, perfusion imaging, positron emission tomography/MR, and functional imaging. Overall this review provides a basis for understudying the role of modern imaging in the care of brain tumor patients.

복부질환 고자장 자기공명영상

나성은 대한의사협회 2010 대한의사협회지 Vol.53 No.12

Due to the development of dedicated receiver coils for 3 tesla (T) magnetic resonance (MR)imaging and increased gradient performance, 3T MR imaging of the abdomen is rapidly becoming a part of routine clinical practice. The most important advantage of 3T MR imaging is a higher signal-to-noise ratio and contrast-to-noise ratio compared with 1.5T systems, which can be used to improve spatial resolution and shorten image acquisition time. In the abdomen, the improved image quality of non-enhanced and enhanced solid organ imaging, MR angiography,MR cholangiopancreatography, and MR spectroscopy can be obtained at 3T due to the increased signal-to-noise ratio and contrast-to-noise ratio. However, 3T abdominal MR imaging also presents several technical challenges, such as increased energy deposition within the patient's body, standing wave artifacts, and increased susceptibility artifacts. Therefore, abdominal MR imaging at 3T requires adjustments in the sequence parameters of pulse sequences designed for 1.5T to optimize image quality. At present, 3T abdominal MR imaging is feasible with high image quality in an acceptable scan time, but 3T imaging is not significantly superior to 1.5T imaging in terms of cost-effectiveness. Future improvements in coil technology and new sequences suitable for 3T may enable wider clinical use of 3T for abdominal MR imaging.

개의 경막외 혈종의 자기공명영상학적 진단

최치봉,김휘율,김수관,배춘식,Choi, Chi-Bong,Kim, Hwi-Yool,Kim, Su-Gwan,Bae, Chun-Sik 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.5

A 3-year-old female, 5kg, Shih-tzu developed an acute onset of depression, disorientation, hypersalivation, nystagmus after falling down 2 meter height place. In plain skull radiography, there was fracture line in the frontal and parietal bones and next day magnetic resonance imaging examination was performed. Magnetic resonance imaging of the brain was performed with 3.0 Tesla unit. Under general anesthesia, the dog was placed in prone with its head positioned in a birdcage coil. Transverse, sagittal and coronal fast spin echo images of the brain were obtained with the following pulse sequences: T1 weighted images (TR = 560 ms and TE = 18.6 ms) and T2 weighted images (TR = 3500 ms and TE = 80 ms). Magnetic resonance imaging showed epidural hematoma in the left frontal area resulting in compression of the adjacent brain parenchyma. Left lateral ventricle was compressed secondarily and the longitudinal fissure shifted to the right, representing mass effect. The lesion was iso-to slightly hyperintense on T1 weighted image and iso-slightly hypointense signal on T2 weighted image. At necropsy, there was a skull fracture and epidural hematoma in the left frontal area. Magnetic resonance imaging of epidural hematoma is reviewed.

자가공명영상(Magnetic Resonance Imaging)의 기본원리

조봉혜,Cho Bong-Hae 대한영상치의학회 1999 Imaging Science in Dentistry Vol.29 No.1

Magnetic resonance imaging with its superior soft tissue contrast resolution and absence of beam hardening artifacts, combined with its ability to perform multiplanar imaging, is now effective tool in diagnostic imagings. Magnetic resonance is primarily a phenomenon that involves atomic nuclei. It provides totally new clinical informations with no known hazards through the use of very weak interactions with endogenous stable magnetic atomic nuclei. This article briefly summarizes the basic mechanism of generation and detection of the signals and general sorts of tissue properties which can influence the signals and thereby give rise to tissue contrast. It also describes how the machine-operating parameters can be used to manipulate the tissue contrast observed in the image.

Inter-vender and test-retest reliabilities of resting-state functional magnetic resonance imaging: Implications for multi-center imaging studies

An, Hyeong Su,Moon, Won-Jin,Ryu, Jae-Kyun,Park, Ju Yeon,Yun, Won Sung,Choi, Jin Woo,Jahng, Geon-Ho,Park, Jang-Yeon Elsevier 2017 Magnetic resonance imaging Vol.44 No.-

<P><B>Abstract</B></P> <P>This prospective multi-center study aimed to evaluate the inter-vendor and test-retest reliabilities of resting-state functional magnetic resonance imaging (RS-fMRI) by assessing the temporal signal-to-noise ratio (tSNR) and functional connectivity. Study included 10 healthy subjects and each subject was scanned using three 3T MR scanners (GE Signa HDxt, Siemens Skyra, and Philips Achieva) in two sessions. The tSNR was calculated from the time course data. Inter-vendor and test-retest reliabilities were assessed with intra-class correlation coefficients (ICCs) derived from variant component analysis. Independent component analysis was performed to identify the connectivity of the default-mode network (DMN). In result, the tSNR for the DMN was not significantly different among the GE, Philips, and Siemens scanners (<I>P</I> =0.638). In terms of vendor differences, the inter-vendor reliability was good (ICC=0.774). Regarding the test-retest reliability, the GE scanner showed excellent correlation (ICC=0.961), while the Philips (ICC=0.671) and Siemens (ICC=0.726) scanners showed relatively good correlation. The DMN pattern of the subjects between the two sessions for each scanner and between three scanners showed the identical patterns of functional connectivity. The inter-vendor and test-retest reliabilities of RS-fMRI using different 3T MR scanners are good. Thus, we suggest that RS-fMRI could be used in multicenter imaging studies as a reliable imaging marker.</P>

Evaluation of the keyhole technique applied to the proton resonance frequency method for magnetic resonance temperature imaging

Han, YongHee,Mun, ChiWoong Wiley Subscription Services, Inc., A Wiley Company 2011 Journal of magnetic resonance imaging Vol.34 No.5

<P><B>Abstract</B></P><P><B>Purpose:</B></P><P>To evaluate the temporal and spatial resolution of magnetic resonance (MR) temperature imaging when using the proton resonance frequency (PRF) method combined with the keyhole technique.</P><P><B>Materials and Methods:</B></P><P>Tissue‐mimicking phantom and swine muscle tissue were microwave‐heated by a coaxial slot antenna. For the sake of MR hardware safety, MR images were sequentially acquired after heating the subjects using a spoiled gradient (SPGR) pulse sequence. Reference raw (<I>k</I>‐space) data were collected before heating the subjects. Keyhole temperature images were reconstructed from full <I>k</I>‐space data synthesized by combining the peripheral phase‐encoding part of the reference raw data and the center phase‐encoding keyhole part of the time sequential raw data. Each keyhole image was analyzed with thermal error, and the signal‐to‐noise ratio (SNR) was compared with the self‐reference (nonkeyhole) images according to the number of keyhole phase‐encoding (keyhole‐data size) portions.</P><P><B>Results:</B></P><P>In applied keyhole temperature images, smaller keyhole‐data sizes led to more temperature error increases, but the SNR did not decreased comparably. Additionally, keyhole images with a keyhole‐data size of <16 had significantly different temperatures compared with fully phase‐encoded self‐reference images (<I>P</I> < 0.05).</P><P><B>Conclusion:</B></P><P>The keyhole technique combined with the PRF method improves temporal resolution and SNR in the measurement of the temperature in the deeper parts of body in real time. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.</P>

One-pot synthesis of magnetic nanoclusters enabling atherosclerosis-targeted magnetic resonance imaging

Kukreja, Aastha,Lim, Eun-Kyung,Kang, Byunghoon,Choi, Yuna,Lee, Taeksu,Suh, Jin-Suck,Huh, Yong-Min,Haam, Seungjoo Dove Medical Press 2014 INTERNATIONAL JOURNAL OF NANOMEDICINE Vol.9 No.-

<P>In this study, dextran-encrusted magnetic nanoclusters (DMNCs) were synthesized using a one-pot solution phase method for detection of atherosclerosis by magnetic resonance imaging. Pyrenyl dextran was used as a surfactant because of its electron-stabilizing effect and its amphiphilic nature, rendering the DMNCs stable and water-dispersible. The DMNCs were 65.6±4.3 nm, had a narrow size distribution, and were superparamagnetic with a high magnetization value of 60.1 emu/g. Further, they showed biocompatibility and high cellular uptake efficiency, as indicated by a strong interaction between dextran and macrophages. In vivo magnetic resonance imaging demonstrated the ability of DMNCs to act as an efficient magnetic resonance imaging contrast agent capable of targeted detection of atherosclerosis. In view of these findings, it is concluded that DMNCs can be used as magnetic resonance imaging contrast agents to detect inflammatory disease.</P>

Single-Slab 3D Fast Spin Echo Imaging: T1-Contrast Perspective

Park Jaeseok 대한자기공명의과학회 2023 Investigative Magnetic Resonance Imaging Vol.27 No.3

Fast spin echo (FSE) in magnetic resonance imaging has long been a main workhorse in clinical routines due to its versatile image contrast and robustness in improving magnetic field inhomogeneities. Nevertheless, the conventional high flip angle strategy limits its imaging efficiency, including high energy deposition to subjects, prolonged imaging time due to a necessarily short echo train, and substantial signal modulation along the echo train. Particularly, achieving high resolution T1-weighted imaging within a reasonable imaging time is challenging due to a very short echo train. In this review, we introduce T1- optimized single-slab 3D FSE imaging with variable refocusing flip angles as a promising solution to the above problems with its clinical applications. We provide a general description of a single-slab 3D pulse sequence and introduce its T1-optimized version with the required configuration of radio frequency and gradient pulses. Subsequently, the T1- weighted single-slab 3D FSE is investigated for signal evolution along the echo train, image contrasts, and flow sensitivity. Given the characteristics of high T1-weighted contrast and flow sensitivity, we demonstrate the clinical application of the single-slab 3D FSE, including high resolution structural imaging, as an alternative to conventional magnetization prepared spoiled gradient echo, highly tumor-targeted contrast-enhanced imaging for efficient detection of small metastases, and high-resolution vessel wall imaging for stroke diagnosis.

Optimization of the Flip Angle and Scan Timing in Hepatobiliary Phase Imaging Using T1-Weighted, CAIPIRINHA GRE Imaging

Kim, Jeongjae,Kim, Bong Soo,Lee, Jeong Sub,Woo, Seung Tae,Choi, Guk Myung,Kim, Seung Hyoung,Lee, Ho Kyu,Lee, Mu Sook,Lee, Kyung Ryeol,Park, Joon Hyuk Korean Society of Magnetic Resonance in Medicine 2018 Investigative Magnetic Resonance Imaging Vol.22 No.1

Purpose: This study was designed to optimize the flip angle (FA) and scan timing of the hepatobiliary phase (HBP) using the 3D T1-weighted, gradient-echo (GRE) imaging with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique on gadoxetic acid-enhanced 3T liver MR imaging. Materials and Methods: Sixty-two patients who underwent gadoxetic acid-enhanced 3T liver MR imaging were included in this study. Four 3D T1-weighted GRE imaging studies using the CAIPIRINHA technique and FAs of $9^{\circ}$ and $13^{\circ}$ were acquired during HBP at 15 and 20 min after intravenous injection of gadoxetic acid. Two abdominal radiologists, who were blinded to the FA and the timing of image acquisition, assessed the sharpness of liver edge, hepatic vessel clarity, lesion conspicuity, artifact severity, and overall image quality using a five-point scale. Quantitative analysis was performed by another radiologist to estimate the relative liver enhancement (RLE) and the signal-to-noise ratio (SNR). Statistical analyses were performed using the Wilcoxon signed rank test and one-way analysis of variance. Results: The scores of the HBP with an FA of $13^{\circ}$ during the same delayed time were significantly higher than those of the HBP with an FA of $9^{\circ}$ in all the assessment items (P < 0.01). In terms of the delay time, images at the same FA obtained with a 20-min-HBP showed better quality than those obtained with a 15-min-HBP. There was no significant difference in qualitative scores between the 20-min-HBP and the 15-min-HBP images in the non-liver cirrhosis (LC) group except for the hepatic vessel clarity score with $9^{\circ}$ FA. In the quantitative analysis, a statistically significant difference was found in the degree of RLE in the four HBP images (P = 0.012). However, in the subgroup analysis, no significant difference in RLE was found in the four HBP images in either the LC or the non-LC groups. The SNR did not differ significantly in the four HBP images. In the subgroup analysis, 20-min-HBP imaging with a $13^{\circ}$ FA showed the highest SNR value in the LC-group, whereas 15-min-HBP imaging with a $13^{\circ}$ FA showed the best value of SNR in the non-LC group. Conclusion: The use of a moderately high FA improves the image quality and lesion conspicuity on 3D, T1-weighted GRE imaging using the CAIPIRINHA technique on gadoxetic acid, 3T liver MR imaging. In patients with normal liver function, the 15-min-HBP with a $13^{\circ}$ FA represents a feasible option without a significant decrease in image quality.