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자기공명영상 신경조영술: 경험이 적은 영상의학과 의사가 이해해야 할 몇 가지 쟁점들
하동호 대한영상의학회 2020 대한영상의학회지 Vol.81 No.1
Magnetic resonance neurography (MRN) has been increasingly used in recent years for the assessment of peripheral neuropathies. Fat suppression T2-weighted imaging (T2WI) and diffusion- weighted imaging (DWI) have typically been used to provide high contrast MRN. Isotropic 3-dimensional (3D) sequences with fast spin echo, post-processing imaging techniques, and fast imaging methods, among others, allow good visualization of peripheral nerves that have a small diameter, complex anatomy, and oblique course within a reasonable scan time. However, there are still several issues when performing high contrast and high resolution MRN including standard sequence; fat saturation techniques; balance between resolution, field of view, and slice thickness; post-processing techniques; 2D vs. 3D image acquisition; different T2 contrasts between proximal and distal nerves; high T2 signal intensity of adjacent veins or joint fluid; geometric distortion; and appropriate p-values on DWI. The proper understanding of these issues will help novice radiologists evaluate peripheral neuropathies using MRN. 말초신경병증의 진단을 위해 MR neurography의 사용이 점차 증가하고 있다. 고대조도와고해상도로 말초신경을 직접 영상화한 MR 영상을 MR neurography라고 하고, 지방억제 T2 강조영상과 확산강조영상이 흔히 사용되는 시퀀스이다. 작은 직경, 복잡한 해부학적 구조를가진 말초신경을 합리적 시간 안에 영상화하기 위해서 최신의 isotropic 3차원 기법, 다양한고속영상기법, post-processing 영상 기법 등이 사용된다. 이런 발전들로 인해 MR neurography가유용하게 사용되지만 항상 적절한 MR neurography 영상을 얻을 수 있는 것은 아니다. 적절한 MR neurography 영상을 얻기 위해 영상의학과 의사가 고려해야 할 다음의 몇가지 쟁점들이 있다. 이에는 적절한 표준 프로토콜의 선책, 지방억제 기법의 선택, 해상도와field of view와 slice thickness 간의 상호 관계의 이해, 적절한 post-processing 영상 기법의적용, 2차원 영상획득 기법과 3차원 영상획득 기법의 장단점, 근위부 말초신경과 말단부 말초신경의 T2 대조도의 차이, 말초신경에 인접한 정맥이 MR neurography에 미치는 영향, 확산강조영상에서 기하학적 왜곡의 발생과 적절한 b value의 선택 등이다. 이런 쟁점들을 잘이해하는 것이 경험이 적은 영상의학과 의사가 적절한 MR neurography 영상을 얻고, 말초신경병증을 정확히 평가하는 데 많은 도움이 될 것이다.
Ultrasonographic Findings of Scleredema Adultorum of Buschke Involving the Posterior Neck
하동호,Myung Jin Lee,Su-Jin Kim 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.3
Objective: To describe the clinical and ultrasonographic (US) findings in patients with scleredema adultorum of Buschke, who presented with sclerotic skin on their posterior neck. Materials and Methods: After obtaining IRB approval, eight patients with scleredema adultorum of Buschke were enrolled. They underwent US examination of their posterior neck. The diagnoses were confirmed pathologically. The clinical history and US images were evaluated retrospectively. Dermal thickness was compared between the patient group and the age- and sex-matched control group. Results: The patients included seven males and one female with a mean age of 51.5 years. All patients presented with thickening of the skin and/or a palpable mass on the posterior neck. Five (62.5%) of the eight patients showed erythematous discoloration. Six patients (75.0%) had a history of diabetes. The Hemoglobin A1c level was found to be increased in all patients. US images did not show any evidence of a soft tissue mass or infection. The mean dermal thickness in patients (7.01 ± 1.95 mm) was significantly greater than that in the control group (3.08 ± 0.87 mm) (p = 0.001). Multiple strong echogenic spots in the dermis were seen in all patients. Seven patients (87.5%) showed posterior shadowing in the lower dermis. Conclusion: When a patient with a history of diabetes presents with a palpable mass or erythematous discoloration of the posterior neck and US shows the following imaging features: 1) no evidence of a soft tissue mass or infection, 2) thickening of the dermis, 3) multiple strong echogenic spots and/or posterior shadowing in the dermis, scleredema adultorum of Buschke should be considered in the differential diagnosis.
하동호,최순섭,이진화,윤성국,남경진,강명진 대한영상의학회 2009 대한영상의학회지 Vol.61 No.4
Purpose: This study was designed to evaluate the usefulness of diffusion tensor imaging (DTI) and the DTI indices for differentiating between microangiopathy lesions, acute infarction lesions and perfusion-diffusion mismatch areas. Materials and Methods: DTI was performed in 35 patients with the use of a 1.5 Tesla MRI system. The MRI parameters were as follows: a spin echo EPI sequence with a bvalue= 1000 s/mm², 25 diffusion directions, a repetition time of 8400 msec, an echo time of 75 msec, a matrix size of 128 128, a FOV of 22 cm and a 4 mm slice thickness. From the diffusion tensor images, the apparent diffusion coefficient (ADC), fractional anisotropy (FA), volume ratio (VR), relative anisotropy (RA), anisotropy index (AI), exponential ADC (eADC) and magnitude diffusion coefficient (MDC) were measured for the contra-lateral normal area (28 cases), the microangiopathy lesions (10 cases), the infarction lesions (17 cases) and the perfusion-diffusion mismatch area (8 cases). Results: As compared to the normal area, the microangiopathy lesions showed increased ADC and MDC values and decreased FA, VR, RA, AI and eADC values. The infarction lesions showed increased VR, RA and eADC values, a normal FA, a decreased AI and decreased ADC and MDC values. The mismatch area showed a similar pattern as that for the microangiopathy lesions; however, the differences were not prominent, with an increase of the ADC and MDC values and a decrease of FA, VR, RA, AI and eADC values. Conclusion: The DTI indices could have a role in making the differential diagnosis of microangiopathy, acute infarction and perfusion-diffusion mismatch lesions.