1.Usefulness of CT Perfusion in the Postoperative Evaluation of Ruptured Aneurysm.
Ji Hoon KANG ; Myeng Sub LEE ; Jhin Soo PYEN ; Hun Joo KIM ; Chul HU ; Kum WHANG
Korean Journal of Cerebrovascular Surgery 2006;8(3):163-171
OBJECTIVE: Our goal was to evaluate the usefulness of CT perfusion (CTP) in early detection of the post operative cerebral ischemia, alteration of treatment modality and patient prognosis in cerebral aneurysm patients. METHODS: 24 patients who underwent either surgical operation or endovascular coiling for ruptured aneurysms were selected. All patients undertook an angiogram, conventional CT, and CTP scan immediately following surgical operation or endovascular coiling. All patients performed a CT 2 weeks after treatment to evaluate possible development of a cerebral infarction. Postoperative CT results of patients with abnormal postoperative CTP scan findings were compared, and these results were compared with the CT results and clinical symptoms of patients who developed infarction or not. RESULTS: Of the 24 patients evaluated, 11 patients showed abnormal findings on CTP. 9 patients were diagnosed with cerebral infarction through a CT scan done 2 weeks after treatment; all exhibited abnormal CTP results immediately after treatment. Abnormal CTP findings were divided into two groups; patients with abnormal CBF and MTT maps, but with normal CBV maps, and patients with abnormal CBF, CBV and MTT maps. A correlation was seen between abnormality on CBV maps and cerebral infarction. Patients with abnormal CTP findings also exhibited poorer prognostic value. CONCLUSION: Postoperative CTP in ruptured aneurysm patients is a very useful and objective tool in evaluating abnormal cerebral hemodynamics. The CBV map of CTP is the most precisely predictable value of postoperative patient's status and alteration of treatement modality.
Aneurysm, Ruptured*
;
Brain Ischemia
;
Cerebral Infarction
;
Cytidine Triphosphate
;
Hemodynamics
;
Humans
;
Infarction
;
Intracranial Aneurysm
;
Perfusion*
;
Prognosis
;
Tomography, X-Ray Computed
2.Hemolytic Crisis and Acute Kidney Injury in Patient with Paroxysmal Nocturnal Hemoglobinuria in Korea : Case Report and Review of Literature.
Yun Deok KIM ; Jae Won YANG ; Jeong Wook CHOI ; Bi Ro KIM ; Jong Myeng YU ; Young Sub KIM ; Jong In LEE ; Seung Ok CHOI ; Byoung Geun HAN
Korean Journal of Nephrology 2009;28(3):236-242
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
Acute Kidney Injury
;
Adult
;
Biopsy
;
Early Diagnosis
;
Female
;
Gastroenteritis
;
Hematopoiesis
;
Hematopoietic Stem Cells
;
Hemoglobinuria, Paroxysmal
;
Hemolysis
;
Hemosiderin
;
Humans
;
Iron
;
Kidney
;
Korea
;
Necrosis
;
Renal Dialysis
;
Thrombosis
;
Venous Thrombosis
3.Comparison of Three, Motion-Resistant MR Sequences on Hepatobiliary Phase for Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced MR Imaging of the Liver.
Doo Ri KIM ; Bong Soo KIM ; Jeong Sub LEE ; Guk Myung CHOI ; Seung Hyoung KIM ; Myeng Ju GOH ; Byung Cheol SONG ; Mu Sook LEE ; Kyung Ryeol LEE ; Su Yeon KO
Investigative Magnetic Resonance Imaging 2017;21(2):71-81
PURPOSE: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. MATERIALS AND METHODS: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-to-liver contrast-to-noise ratio (CNR). The results were compared, using repeated post-hoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. RESULTS: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). CONCLUSION: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.
Acceleration
;
Artifacts
;
Humans
;
Liver*
;
Magnetic Resonance Imaging*
;
Retrospective Studies
;
Signal-To-Noise Ratio
4.Comparison of Three, Motion-Resistant MR Sequences on Hepatobiliary Phase for Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced MR Imaging of the Liver.
Doo Ri KIM ; Bong Soo KIM ; Jeong Sub LEE ; Guk Myung CHOI ; Seung Hyoung KIM ; Myeng Ju GOH ; Byung Cheol SONG ; Mu Sook LEE ; Kyung Ryeol LEE ; Su Yeon KO
Investigative Magnetic Resonance Imaging 2017;21(2):71-81
PURPOSE: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. MATERIALS AND METHODS: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-to-liver contrast-to-noise ratio (CNR). The results were compared, using repeated post-hoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. RESULTS: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). CONCLUSION: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.
Acceleration
;
Artifacts
;
Humans
;
Liver*
;
Magnetic Resonance Imaging*
;
Retrospective Studies
;
Signal-To-Noise Ratio