Effect of Prostate Biopsy Hemorrhage on MRDW and MRS Imaging

이종연,장인호,문영태,김경도,명순철,김태형,이종범 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.10

Purpose: To retrospectively evaluate the effect of post-prostate-biopsy hemorrhage on the interpretation of magnetic resonance diffusion-weighted (MRDW) and magnetic resonance spectroscopic (MRS) imaging in the detection of prostate cancer. We also investigated the optimal timing for magnetic resonance examination after prostate biopsy. Materials and Methods: We reviewed the records of 135 men. All patients underwent prostate magnetic resonance imaging (MRI). The prostate was divided into eight regions according to the biopsy site. Subsequently, we measured hemorrhage on apparent diffusion coefficient (ADC) values and (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratios in the same regions on the MRI. We investigated the effect of hemorrhage at ADC values and (Cho+Cr)/Cit ratios on MRI and the relationship between prostate biopsy results and MRI findings. Results: The mean patient age was 68.7 years and the mean time between biopsy and MRI was 23.5 days. The total hemorrhagic score demonstrated no significant associations with intervals from biopsy to MRI. Higher hemorrhagic scores were associated with higher ADC values, prostate cancer, and noncancer groups, respectively (p<0.001). ADC values were lower in tumors than in normal tissue (p<0.001), and ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001). However, (Cho+Cr)/Cit ratios did not exhibit any association with prostate biopsy results and hemorrhage. Conclusions: Hemorrhage had no significant associations with the interval from biopsy to MRI. ADC values may help to detect prostate cancer and predict the aggressiveness of cancer; however, it is important to consider the bias effect of hemorrhage on the interpretation of MRDW imaging given that hemorrhage affects ADC values. Purpose: To retrospectively evaluate the effect of post-prostate-biopsy hemorrhage on the interpretation of magnetic resonance diffusion-weighted (MRDW) and magnetic resonance spectroscopic (MRS) imaging in the detection of prostate cancer. We also investigated the optimal timing for magnetic resonance examination after prostate biopsy. Materials and Methods: We reviewed the records of 135 men. All patients underwent prostate magnetic resonance imaging (MRI). The prostate was divided into eight regions according to the biopsy site. Subsequently, we measured hemorrhage on apparent diffusion coefficient (ADC) values and (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratios in the same regions on the MRI. We investigated the effect of hemorrhage at ADC values and (Cho+Cr)/Cit ratios on MRI and the relationship between prostate biopsy results and MRI findings. Results: The mean patient age was 68.7 years and the mean time between biopsy and MRI was 23.5 days. The total hemorrhagic score demonstrated no significant associations with intervals from biopsy to MRI. Higher hemorrhagic scores were associated with higher ADC values, prostate cancer, and noncancer groups, respectively (p<0.001). ADC values were lower in tumors than in normal tissue (p<0.001), and ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001). However, (Cho+Cr)/Cit ratios did not exhibit any association with prostate biopsy results and hemorrhage. Conclusions: Hemorrhage had no significant associations with the interval from biopsy to MRI. ADC values may help to detect prostate cancer and predict the aggressiveness of cancer; however, it is important to consider the bias effect of hemorrhage on the interpretation of MRDW imaging given that hemorrhage affects ADC values.

재출혈에 따른 면역학적 변화

이한식,조광현,손대곤,박준석,이종호,정성필 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: This study evaluates whether the adaptation mechanism could modulate immunosuppression following a hemorrhage. Methods: Minor hemorrhage (10% of total blood volume) was induced in the rat model, 1, 2, 4, and 7 days before the main hemorrhage. The immune responses were observed by measuring Con A (Concanavalin A) stimulated proliferative capacity of the peripheral lymphocyte subpopulations, and the Interleukin-2 (IL-2) release from splenocytes. Results: The proliferative capacity of the splenocytes(SPC) decreased in two days interval mod@ with hemorrhages more than 20% of the total blood volume. The SPC increased in the group with 10% hemorrhage pretreatment 7 days prior to 20% main hemorrhage than it was for 20% or 30% main hemorrhage only with cardiac puncture groups. The SPC increased on the first day than it was on the fourth day after the 20% main hemorrhage, in the pretreatment group with 7 days interval. The amount of IL-2 release by the splenocytes was higher in the 10-20% group (10% pretreatment hemorrhage and 20% main hemorrhage) than it was in the 0-30% group, when the hemorrhage interval was 7 days, and it was higher on the first day than on the fourth day after the second hemorrhage in the 10-20% group. Conclusion: The immune response varied depending on the hemorrhage interval following pretreatment, and it increased after the main hemorrhage that, by itself, would cause immunosuppression. But this effect, however, was only observed during a short period (about 1 day) following the second hemorrhage.

기계환기 적용 중 발생한 두개강내출혈 환자의 임상적 특성과 예후

김고운,허진원,고윤석,임채만,홍상범 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.2

Background: Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU. Methods: We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage. Results: Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage. Conclusions: Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.

Examination of the Cerebellomedullary Cistern Using Postmortem Computed Tomography in Various Types of Intracranial Hemorrhage

허진행,임상범,장선정,권정화,나주영 대한법의학회 2023 대한법의학회지 Vol.47 No.4

Intracranial hemorrhage is a major cause of sudden unexpected death and its identification is important for death investigations. Cisternal puncture of the cerebellomedullary cistern (CMC) can be used to identify intracranial hemorrhage during postmortem examination. Intracranial hemorrhage comprises various types of hemorrhage, and the possibility of hemorrhage identification by cisternal puncture can differ according to the type of intracranial hemorrhage. Postmortem computed tomography (PMCT) is non-invasive and can be performed before autopsy. In this study, we aimed to identify the hemorrhage in the CMC using PMCT in cases of various intracranial hemorrhage. PMCT was performed before the autopsy. Autopsy reports and PMCT were retrospectively reviewed for 108 cases of intracranial hemorrhage confirmed by conventional autopsy. Hemorrhagic regions showed ≥60 Hounsfield units on PMCT. Hemorrhage in the CMC was identified in 42.6% (46/108) by PMCT and was frequently identified in the cases of basal subarachnoid hemorrhage (SAH) (19/21). Hemorrhage in the CMC was identified in approximately 50% of patients with non-basal SAH and intracerebral hemorrhage. Detection of hemorrhage in the CMC by PMCT is hindered by several factors, such as dental artifacts. This study does not guarantee the usefulness of postmortem cisternal puncture. However, this study verified hemorrhage in the CMC according to the various types of intracranial hemorrhages using PMCT and showed its possibilities and limitations.

뇌종양에 의한 두개강내 출혈

이상형,왕규창,김종수,이선호,김현집,조병규,한대희,심보성,최길수 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

919 consecutive brain tumor cases and 665 consecutive spontaneous intracranial hemorrhage cases were reviewed for the analysis of cases in which spontaneous intracranial hemorrhage caused by brain tumor was confirmed with gross operative findings. Authors analyzed their incidence, patients' demography, tumor histology, clinical symptoms and signs, predisposing factor, tumor vascularity, type of hemorrhage, relations between the clinical symptoms and signs and the type of hemorrhage, relations between the location of tumor and the type of hemorrhage and the outcome of treatment. The conclusions are as follow ; 1) The proportion of the hemorrhage caused by brain tumor to the total spontaneous intracranial hemorrhage was 5.1%(34/665). 2) The proportion of the spontaneous intracranial hemorrhage caused by brain tumor to the total brain tumor was 3.7%(34/919) and the proportion of that excluding pituitary adenoma was 2.5% (18/729). 3) Compared with the other brain tumors, oligodendroglioma and pituitary adenoma had significant tendency of hemorrhage (p<0.05, p<0.01, respectively) and meningioma had a significantly low incidence of hemorrhage(p<0.05). 4) The hemorrhage brought about major symptoms in 13 cases(72%), minor symptoms in 2 cases (11%). Three cases showed no symptoms related to the hemorrhage. 5) Among the 18 cases of spontaneous intracranial hemorrhage caused by brain tumor, one case with the major attack died of postoperative pneumonia. There were additional 2 motalities which were not related to the preoperative hemorrhage. And most of the symptoms associated with the preoperative hemorrhage stabilized or improved with operative treatment.

자발성 뇌출혈의 치료 : Medical versus Surgical Therapy for Spontaneous Intracerebral Hemorrhage

김태호,정신,이제혁,박종근,김재휴,김수한,강삼석 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

The results of treatment for 248 patients with spontaneous intracerebral hemorrhage are described. Spontaneous intracerebral hemorrhage are classified into primary(215 patients) and secondary(33 patients) hemorrhages. Most of the secondary hemorrhages were located in the subcortical area(64%). In the Non-treated group, eighty patients died immediately after diagnosis. In the treated group, the overall mortality was 5% in primary hemorrhage and 15% in secondary hemorrhages, and the percentages of hypertensive intracerebral hemorrhage patients returning to full-time work or independent life without disability or with minimal disability were 30% in putaminal hemorrhages, 86% in caudate hemorrhages, 44% in thalamic hemorrhages, 61% in subcortical hemorrhage, 78% in cerebellar hemorrhages and 40% in brainstem hemorrhages respectively. This study showed that surgical treatment did not give better result over conservative treatment in the management of hypertensive supratentorial and brainstem hemorrhage. However hypertensive caudate and cerebellar hemorrhage were associated with favorable outcomes regardless of the mode of therapy chosen in severe hemorrhages, surgery may improve the length of survival, but the quality of life remains poor. The authors have shown again that aspiration surgery for hypertensive cerebellar hemorrhage is a valuable alternative to craniotomy.

고혈압성 뇌실질내출혈의 장기추적결과의 평가 : 외과적 및 보존적 치료의 비교연구 A Comparative Study of Surgical and Conservative Treatment in 1009 Cases

임영진,이기홍,김태성,김국기,이봉암,임언 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.8-9

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time : or 3) lack of proper classification of hematomas for comparison of results from different institutions. The author analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical centre for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ratio was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhages had brought about a high incidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade Ⅰ-Ⅱ, and also decreased the frequency of Grade Ⅲ. but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.

근적외선을 이용한 두개강내 혈종의 진단

박정율,홍기선,김상대,김세훈,임동준,조태형 대한체열학회 2003 대한체열진단학회지 Vol.3 No.1

Development of Submacular Hemorrhage in Neovascular Age-related Macular Degeneration: Influence on Visual Prognosis in a Clinical Setting

Young Suk Chang,Jae Hui Kim,Jong Woo Kim,Chul Gu Kim,Dong Won Lee 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.5

Purpose: This study aimed to evaluate changes in visual acuity before and after the development of submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and to compare the visual outcomes between patients with and without hemorrhage. Methods: This retrospective observational study included 124 patients with neovascular AMD. Patients who developed a submacular hemorrhage involving the fovea were included in the hemorrhage group (n = 55). Patients with no sign of submacular hemorrhage during the follow-up period were included in the no-hemorrhage group (n = 69). Visual outcomes were compared between the two groups. Results: The logarithm of the minimal angle of resolution best-corrected visual acuity (BCVA) before the development of submacular hemorrhage, once the hemorrhage had developed, and 6 months after the development of hemorrhage was 0.59 ± 0.45, 1.24 ± 0.57, and 0.99 ± 0.64, respectively. BCVA was significantly worse 6 months after the hemorrhage compared to before the hemorrhage (p < 0.001). The BCVA before the development of hemorrhage (measured at a mean of 12.9 months after diagnosis) was comparable to that of the no-hemorrhage group (mean, 0.58 ± 0.37 at a mean of 12.4 months). However, the BCVA 6 months after identification of hemorrhage (mean, 21.5 months) was significantly worse in the hemorrhage group than in the no-hemorrhage group (mean, 0.73 ± 0.44 at mean 21.2 months) (p = 0.018). Conclusions: Visual acuity was significantly worse after hemorrhage than before hemorrhage, even after treatment. In addition, patients with submacular hemorrhage had markedly worse visual outcomes than patients without hemorrhage. This result suggests that the development of hemorrhage during the treatment course of neovascular AMD has a devastating effect on visual prognosis.

재발된 고혈압성 뇌실질내 출혈

박상익,강동기,김상철 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.11

Thirty six consecutive patients with recurrent hypertensive intracerebral hemorrhage were identified in a retrospective review of 307 cases of hypertensive intracerebral hemorrhage(HICH) treated at the Fatima Hospital between September, 1989, and August, 1992. The recurrence rate was 11.7%. There were 14 males and 22 females, aged 38 to 83 years. Only one patient had recieved regular antihypertensive therapy after initial hemorrhage. The mean volume of hemorrhage was 21.7㏄ at first attack and 19.5㏄ at recurrent attack. The site of recurrent hemorrhage was putamen in 18 cases, thalamus in 12 cases, cerebellum in 8 cases and lobar in 3 cases. The most common pattern of recurrence was "Ganglionic-Ganglionic"(10cases). Recument hemorrhage occured at the same side in 54.8% and same side & same site in 16.7% of recurrent hemorrhage. Mean interval between the hemorrhage was 17.4 months and 55.8% of recurrent hemorrhage occured within 1 yeat. Initial condition was worse at recurrent hemorrhage and outcome also was worse regardless of treatment methods. We concluded that recurrent intracerebral hemorrhage in HICH patients was not a rare condition and regular follow up and antihypertensive therapy was important in prevention of recurrent hypertensive intracerebral hemorrhage.