PURPOSE: To investigate the applicability of the new three-dimensional overlapped reconstruction MR angiography (3-D ORMRA) technique in patients with hemifacial spasm and to compare the new 3-D reconstruction images with conventional MRA source images. MATERIALS AND METHODS: The study group comprised 27 patients with surgically proven hemifacial spasm. In all patients, conventional MRA source images and 3-D fast imaging employing steady-state acquisition (FIESTA) images were obtained prospectively. After 3-D MR angiographic images were obtained, the 3-D MRA and FIESTA images were overlapped at the workstation by using GE A/W 4.2 add/sub software. We analyzed the relationship between the offending vessels and root exit zone of the facial nerve using both 3-D ORMRA images and conventional MRA source images. RESULTS: In 25 of 27 patients, the offending vessel at the REZ of the facial nerve could be correctly identified on conventional MRA source images. In all patients, the presumed offending vessels depicted by the overlapped 3-D reconstruction MRA image corresponded well with the intraoperative findings. The 3-D reconstruction image showed more clear visualization of the spatial relationship between the offending vessels and the root exit zone of the facial nerve. CONCLUSION: The overlapped 3-D reconstruction MR angiography technique is very useful and informative in patients with hemifacial spasm, as compared with conventional MRA angiography technique.
Angiography ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Prospective Studies

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

PURPOSE: To evaluate the usefulness and reproducibility of 1H MRS in different 1.5 T MR machines with different coils to compare the SNR, scan time and the spectral patterns in different brain regions in normal volunteers. MATERIALS AND METHODS: Localized 1H MR spectroscopy (1H MRS) was performed in a total of 10 normal volunteers (age; 20-45 years) with spectral parameters adjusted by the autoprescan routine (PROBE package). In all volunteers, MRS was performed in a three times using conventional MRS (Signa Horizon) with 1 channel coil and upgraded MRS (Echospeed plus with EXCITE) with both 1 channel and 8 channel coil. Using these three different machines and coils, SNRs of the spectra in both phantom and volunteers and (pre)scan time of MRS were compared. Two regions of the human brain (basal ganglia and deep white matter) were examined and relative metabolite ratios (NAA/Cr, Cho/Cr, and mI/Cr ratios) were measured in all volunteers. For all spectra, a STEAM localization sequence with three-pulse CHESS H2O suppression was used, with the following acquisition parameters: TR=3.0/2.0 sec, TE=30 msec, TM=13.7 msec, SW=2500 Hz, SI=2048 pts, AVG=64/128, and NEX=2/8 (Signa/Echospeed). RESULTS: The SNR was about over 30% higher in Echospeed machine and time for prescan and scan was almost same in different machines and coils. Reliable spectra were obtained on both MRS systems and there were no significant differences in spectral patterns and relative metabolite ratios in two brain regions (p>0.05). CONCLUSION: Both conventional and new MRI systems are highly reliable and reproducible for 1H MR spectroscopic examinations in human brains and there are no significant differences in applications for 1H MRS between two different MRI systems.
Brain* ; Ganglia ; Healthy Volunteers ; Humans* ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy* ; Spectrum Analysis ; Steam ; Volunteers

BACKGROUND AND PURPOSE: Subjective cognitive decline has been proposed as a potential indicator of the preclinical state of Alzheimer's disease (AD). The results of the studies of cortical atrophy on brain MRIs in subjects with subjective cognitive decline are inconsistent across the literatures. We investigated whether subjects with subjective cognitive decline had less gray matter volume compared to controls without subjective cognitive decline as per brain MRI. METHODS: Thirty-six subjects with subjective cognitive decline and thirty-three controls without subjective cognitive decline were recruited retrospectively from among the patients who had visited the department of neurology at Inha University Hospital between January 2008 and December 2010. All subjects had undergone a brain MRI scan including 3D T1-weighted spoiled gradient recalled echo imaging. We used voxel-based morphometry (VBM) to examine gray matter volumes between the two groups, after controlling for age, sex, education, and total intracranial volumes (TIV). RESULTS: There were no significant differences in age, gender, education, and TIV between the two groups. In comparison to controls without subjective cognitive decline, subjects with subjective cognitive decline showed gray matter atrophy in the left superior and medial frontal gyri, left superior and inferior parietal lobules, and right precuneus and insular in the VBM analysis. CONCLUSIONS: Individuals with subjective cognitive decline encountered in clinical settings have greater similarity to an AD gray matter atrophy pattern compared with cognitively normal individuals without subjective cognitive decline.
Alzheimer Disease ; Atrophy ; Brain ; Education ; Humans ; Magnetic Resonance Imaging ; Neurology ; Rabeprazole ; Retrospective Studies

BACKGROUND: Fungus is the common pathogen of nosocomial infection, and the 4th common pathogen of nosocomial bloodstream infection. We evaluated the annual occurrence, the relation between fungemia and central venous catheter-related infection, the risk factors and survival rate of fungemia. METHODS: We reviewed medical record of 209 cases with fungemia occurred in the period of from 1992 to 1997 in Severance hospital retrospectively. RESULTS: The annual occurrence of nosocomial fungemia was 3.9, 6.7, 6.7, 7.8, 13.6, 8.0, per 10,000 patient discharges in 1992, 1993, 1994, 1995, 1996, 1997. The species of fungemia wete Candida albicans (47.79o), C. glabrata (12.1%), C. parapsilosis (11.7%), C. tropicalis (11.2/o), C. guilliermondii (1.9fo), C. krusei (1.9%), Rhodotorula species (2.3%), Trichosporon species (1.9%), molds (4.7%). The proportion of definite catheter-related bloodstream infection was 41.6%, probable catheter-related bloodstream infection 28.2%, and the fungemia that was not related with central venous catheter infection was 30.1%. Mortality rate of fungemia was 53.6%, and median survival days were 29 days. Catheter removal and antifungal therapy increased survival rate, but persistent fungemia and thrombocytopenia were poor prognostic factors. CONCLUSION: The fungal bloodstream infection is increased and high proportion of fungemia is related to central venous catheter-related infection. Since catheter removal and antifungal therapy have benefit on survival rate, early evaluation of catheter-related infection and antifungal therapy in fungemia patient is recommended.
Candida albicans ; Catheter-Related Infections ; Catheters ; Central Venous Catheters ; Cross Infection ; Fungemia* ; Fungi ; Humans ; Incidence* ; Medical Records ; Mortality ; Patient Discharge ; Retrospective Studies ; Rhodotorula ; Risk Factors ; Survival Rate ; Thrombocytopenia ; Trichosporon

BACKGROUND/AIMS: The most effective method of improving survival in patients with HCC is early diagnosis and curative hepatic resection. However, longterm survival after curative resection remains low because of high recurrence rate after resection. The purpose of the study is to assess the prognosis and the efficacy of the various treatment modalities on recurrent HCC after curative resection. METHODS: The clinical records of 50 patients with recurrent HCC were reviewed retrospectively who underwent curative surgery in Yonsei University, Severance Hospital from Jan. 1987 through Oct. 1994. The cummulative recurrent rate after resection, the response rate of treatment after resection, the median progression free survival and the survival after recurrence according to the treatment modalities were evaluated. RESULTS: The cummulative recurrent rate after resection was 3.9% at 3 month, 8.3% at 6 month, 14.1% at 12 month, 21.5% at 24 month, 23.4% at 36 month and 24.4% at 60 month. The response rate of treatment after recurrence was 23.7% (9 patients). The median progression free survival of the patient with reoperation and hepatic embolization was 13.9 months, that of conservative treatment group was 6.8 months and that of no treatment group was 4 months(p = 0.004). The survival after recurrence of HCC was 19.7 months in reoperation and hepatic embolization group, 11.4 months in multimodality group, 16.9 months in conservative treatment group and 8.4 months in no treatment group(p=0.0998). CONCLUSION: Reoperation and hepatic embolization for HCC after curative resection was effective in improving progression free survival, but overall survival were not significantly different according to the treatment modalities. This results proposed that reoperation and hepatic embolization for recurrent HCC after curative resection improve progression free survival.
Carcinoma, Hepatocellular* ; Disease-Free Survival ; Early Diagnosis ; Humans ; Prognosis* ; Recurrence ; Reoperation ; Retrospective Studies

BACKGROUND/AIMS: To compare treatment outcome of hepatocellular carcinoma(HCC) under the size of 5 cm in relation to underlying liver function and treatment modalities, analysis of data from 145 patients was performed. METHODS: In this study, the records of 145 patients with small HCC (< 5 cm in diameter determined by hepatic angiography) were reviewed. Clinical parameters were analyzed and survival rate, recurrence rate were calculated. RESULTS: There were 107(73.8%) men and 38 women. Mean age at diagnosis was 55.1(range .' 25 83 year-old). HBsAg was detected in 97(66.9%) patients. Seventy two(50.0%) patients showed markedly elevated(>40 ng/mL) serum alpha-fetoprotein(AFP) level. Liver cirrhosis was associated in 109(75.2%) patients. Sixty five(44.8%) patients underwent surge, 63(43.5%) underwent transarterial therapy(TAT), 8(5.5%) underwent other modalities of therapy and the remaining 9(6.2% ) patients did not receive any specific treatment for HCC. In relation to the underlying liver function, 119(82.1% ) patients belonged to the non-cirrhotic or Child-Pugh class A, 20(13.8%) to class B and 6(4.1%) to class C. The median follow-up duration was 21 months. When analyzed with respect to treatment modalities alone, median survival was 43 months for all patients, 60 months for surgery, 29 months for TAT, 20 months for other treatment and 18 months for patients who received no specific treatment. Without considering liver function, cumulative 3 year survival rate was 68.6% for surgery, 43.9% for TAT, 29.2% for other treatment and 0% for no treatment. The survival rate for the patients who underwent surgery was significantly higher than for any other treatment modalities without considering the underlying liver function or in the non-cirrhotic/Child-Pugh class A(p<0.001). In patients whose tumor size was equal to or less than 3 cm, there was no difference in survival rate in relation to the treatment modalities when not considering the underlying liver function of each patient(p>0.05). But in patients classified as the non-cirrhotic/Child-Pugh class A, better survival was observed in the surgep group than the TAT group(p<0.05). The only factor influencing survival was the pre-treatment serum AFP level(p<0.05). The overall recurrence rate was 30.3%. For the entire patients, the factor significantly influencing the recurrence rate was the presence of underlying cirrhosis. When considering only the patients in the surgery group, the different types of surgical procedures significantly influenced the recurrence rate. CONCLUSION: Surgery is the treatment of choice for patients with HCC equal to or smaller than 5 cm. But for those patients whose tumor size is less than 3 cm, TAT may be a reasonable alternative to surgep when the liver function is not adequate for hepatic resection. Because overall recurrence rate exceeded 30% and median time of recurrence was only 9.5 months after definitive treatment, careful follow-up is required for all patients who undergo treatment for small HCC.
Carcinoma, Hepatocellular* ; Diagnosis ; Female ; Fibrosis ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Recurrence ; Survival Rate ; Treatment Outcome*

To observe the characteristics of the posterior aortic wall motions of the patients with various valvular heart diseases the aortic root echocardiogram of the 60 patients with various valvular diseases were examined. 15 cases in each group of patients with mitral stenosis, mitral insufficiency, mitral stenoinsufficiency or aortic insufficiency. Thirty normal subjects were served as a control group. In each, the total amplitude of the aortic posterior wall motion(OV), the amplitude of the motion evented at atrial systole(AV), AV/OV ratio, atrial emptying index(AEI), left atrial and aortic root dimensions (LAD and AOD), and LAD/AOD were measured. The results were as follows ; 1) The AV was significantly increased in mitral stenosis(P<0.01) and decreased in mitral insufficiency(P<0.05) compared with control group. 2) The OV was increase in mitral insufficiency and aortic insufficiency(p<0.01, p<0.05), but decreased in mitral stenosis(p<0.05). 3) The AV/OV was increased in mitral stenosis(p<0.01) and decreased in mitral insufficiency and aortic insufficiency(p<0.01). 4) The AEI was decreased in all patient groups(p<0.01) and LAD was increase in all compared with control group(p<0.01). 5) The AOD was increased only in aortic insufficiency(p<0.01). 6) The LAD/AOD ratio was increased in all patient groups(p<0.01).
Heart Valve Diseases* ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis