Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings

염정아,이인숙,서희붐,송유선,송종운 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.5

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

Change of Apparent Diffusion Coefficient Immediately after Recanalization through Intra-Arterial Revascularization Therapy in Acute Ischemic Stroke

노지은,염정아,김영수,윤창효,박민규,박경필,백승국 대한영상의학회 2016 대한영상의학회지 Vol.74 No.4

Purpose: Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. Materials and Methods: ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Results: Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm2/sec, and increased to 619.08 × 10-6 mm2/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. Conclusion: There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

Transvenous Onyx embolization of cavernous sinus dural arteriovenous fistula using a balloon catheter in the arterial side for flow control

강철후,노지은,염정아,이상원,백승국 대한신경집중치료학회 2019 대한신경집중치료학회지 Vol.12 No.2

Background: Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts involving the dura mater, located within or near the walls of the CS. Transvenous embolization is considered to be an effective treatment for CS DAVF. We describe a novel technique for the use of transvenous Onyx embolization in the treatment of CS DAVF, which uses a temporary balloon to occlude the arterial side for flow control. Case Report: A 63-year-old woman presented with ocular pain and ptosis of the left eye. Cerebral angiography showed a left CS DAVF fed by multiple branches of the left external carotid artery. We successfully treated the CS DAVF using transvenous Onyx embolization with temporary balloon occlusion of the proximal feeding artery to decrease the shunted flow. Conclusion: Transvenous Onyx embolization with flow control via temporary balloon occlusion may be a useful technique for the embolization of CS DAVFs with multiple arterial feeders.

Comparison of Enterprise and Neuroform Stent-Assisted Coil Embolization of Distal Internal Carotid Artery Aneurysms: Midterm Results from a Single-Center Experience

최원진,백승국,염정아,김영수,이상원 대한영상의학회 2014 대한영상의학회지 Vol.70 No.3

Purpose: To compare the mid-term follow-up angiographic findings in distal internal carotid artery (ICA) aneurysms treated by stent-assisted coil embolization using the Enterprise or Neuroform stent. Materials and Methods: We included 68 patients with 70 aneurysms: 31 cases with Enterprise and 39 cases with Neuroform. Inclusion criteria were 1) location of the stent within the distal ICA, including the carotid siphon; 2) follow-up angiogram after > 6 months, and 3) single use of the stent for 1 parent artery. Results: The patients’ mean age was 54.9 years (16 male and 52 female). Mean follow-up duration was 9.1 months. At follow-up, there were intraluminal filling defects of the parent artery in 19.4% of the Enterprise group and no filling defect in the Neuroform group. There was no significant in-stent stenosis in either group. Straightening of the parent artery was seen in 35.5% of the Enterprise group and 20.5% of the Neuroform group. Two Enterprise cases showed delayed migration. Conclusion: The Enterprise showed statistically significant intraluminal filling defects of the parent artery compared with the Neuroform. The rates of significant in-stent stenosis and straightening of the parent artery were not significantly different between the Enterprise and the Neuroform groups.

Physiologic Flow Related Signal Intensity in Dural Sinuses on Time of Flight Magnetic Resonance Angiography: Changes Caused by Head Elevation

노지은,백승국,염정아,김영수,정희석,윤창효,한준희 대한영상의학회 2017 대한영상의학회지 Vol.77 No.6

Purpose: The presence of a flow-related signal in the normal dural sinus time of flight magnetic resonance angiography (TOF MRA) is common. This study aimed to identify changes in signal intensity in the dural sinus caused by changes in patient position. Materials and Methods: The researchers performed an elevation TOF MRA of the cerebral region in 52 patients, who showed abnormal flow-related signals in the dural sinuses on supine position. Flow-related signal intensity in the dural sinuses was then analyzed. Results: Flow-related signals were seen in 114 sites (52 patients), specifically in the internal jugular vein (IJV), sigmoid sinus (SS), inferior petrosal sinus (IPS), and cavernous sinus (CS) in 29 sites, 33 sites, 32 sites, and 20 sites, respectively. After head elevation, flow-related signal changes were then observed in the IJV, SS, IPS, and CS in 107 sites (107/114, 93.9%). There was loss of signal (62/114, 54.4%), or decrease (39/114, 34.2%), increase (6/114, 5.3%), or no change (7/114, 6.1%) in the signal intensity, and flow related signals were more frequent on the left than on the right. Conclusion: Flow-related signals in the dural sinuses on TOF MRA were decreased or disappeared by head elevation in 88.6% of the sites. Head elevation may help distinguish between pathologic and physiologic states.

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

강종수,강철후,노지은,염정아,심동현,김영수,이상원,김영수,박기홍,김창훈,김수경,최낙천,권오영,강희영,백승국 대한신경집중치료학회 2018 대한신경집중치료학회지 Vol.11 No.2

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusions: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

간 외 좌측 담관에 생긴 담관게실의 증례: 증례보고 및 문헌고찰

류화성,김태언,김진혁,노지은,염정아,정희석,류제호,남형석 대한췌담도학회 2019 대한췌담도학회지 Vol.24 No.1

담관의 게실은 Todani 분류에 부합하지 않는 드문 형태의 담관의 낭성 확장이며, 질환의 희소성으로 인하여 진료 현장에서 진단이나 치료에 어려움을 겪을 수 있다. 본 증례보고에서는 복통을 주소로 내원한 57세 여성 환자에서 발생한 간외 좌측 담관 게실의 증례를 문헌고찰과 함께 보고하고자 한다. 내원 당시 환자는 간기능 검사에서의 경미한 증가 외에 혈액검사상 이상 소견은 보이지 않았다. 전산화단층촬영과 자기공명 담도췌관조영술에서 간내담관의 합류 부분 근처에 슬러지 볼을 포함한 낭성 병변이 보였으나 병변의 기원은 명확히 보이지 않았다. 임상적으로는 Todani II형 총담관낭이 의심되었다. 환자의 복통이 지속되어 해당 병변에 대하여 수술적 절제를 시행하였고 수술 결과 좌측 담관 게실로 진단되었다. 절제된 조직은 병리학적 검사상 담도 상피로 덮인 게실로 확인되었다. 수술 후 합병증은 발생하지 않았으며 수술적 제거 후 환자의 증상은 호전되었다. Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.

비인두와 구강인두의 종양에서 겉보기확산계수 값을 통한 감별진단의 유용성

권훈,김학진,설유리,이태홍,염정아,김아롱 대한영상의학회 2012 대한영상의학회지 Vol.66 No.2

Purpose: In several previous studies, apparent diffusion coefficient (ADC) calculation was applied in the evaluation of head and neck tumors and is a promising technique for this application. As a result, we reevaluated the usefulness of ADC measurement with differentiation of benign and malignant pathology in the nasopharynx and oropharynx. Materials and Methods: The study population consisted of 87 consecutive patients who had undergone routine nasopharyngeal and oropharyngeal MR imaging at our institution, which included diffusion weighted image and ADC map, with a clinically suspected primary tumor of nasopharynx and oropharynx. The mean ADC values in the benign and malignant groups were compared and the malignant group was divided into the lymphoma and carcinoma groups. Results: A statistically significant difference in ADC values among the benign and malignant groups using independent samples t-test with a p < 0.001. The lymphoma and carcinoma groups were compared by the Man-Whitney U test, which revealed a statistically significant difference with a p = 0.002. When an ADC of 1.1 × 10-3 mm2/s was used to distinguish between benign and malignancy, accuracy was 85%. Conclusion: ADC values were useful for distinguishing between benign and malignancy in the nasopharynx and oropharynx. 목적: 비인두와 구강인두에서 양성, 악성병변의 조직학적 분류에 따른 겉보기확산계수(apparent diffusion coefficient; 이하 ADC) 값의 차이를 알아보고자 하였다. 대상과 방법: 비인두와 구강인두의 병변에 대하여 조직학적으로 양성 및 악성병변으로 진단받은 87명의 환자(평균연령 53.8세, 연령범위 17~86세, 악성병변 63예, 양성병변 24예)를 대상으로 하였다. 모든 대상환자에서 얻은 자기공명영상 중 ADC 값을 악성병변과 양성병변에서 비교하였고 악성병변 중에서 암종과 림프종의 ADC 값을 다시 비교하였다. 결과: 악성병변의 평균 ADC 값은 양성병변의 평균 ADC 값에 비해 통계적으로 유의하게 낮았다(p = 0.000). 또한 암종과 림프종의 ADC 값은 Man-Whitney U test에서 통계적으로 유의한 차이를 보였다(p = 0.002). 그리고 1.1 × 10-3 mm2/s의 경계값을 적용할 경우 85%의 정확도로 양성병변과 악성병변을 감별할 수 있었다. 결론: 확산강조영상의 ADC 값은 비인두와 구강인두의 병리소견에 따라 의미 있는 차이를 보였고 양성병변과 악성병변을 감별하는 데 유용했다.

상부위장관 내시경 후 악화된 기종성 위염

김태언,김수진,류화성,김진혁,장주연,염정아,노지은,정희석,박병수,김동일 대한상부위장관ㆍ헬리코박터학회 2020 Korean Journal of Helicobacter Upper Gastrointesti Vol.20 No.1

Emphysematous gastritis is an infectious disease in which air is formed in the gastric wall by gas-forming organisms. It is infrequently reported but can be fatal without early diagnosis and treatment. The stomach is rarely infected because of the acidity of the gastric secretions and the rich blood supply. Treatment should be aimed at covering gram-negative organisms and anaerobes using broad-spectrum intravenous antibiotics, and occasional surgical management in order to enhance survival. Risk factors are those that lead to disrupted mucosal integrity, such as corrosive injury, and those that result in an immunosuppressed condition, including diabetes mellitus, chronic kidney disease, immunosuppressive drug use, and subsequent invasion by gas-forming organisms. We experienced a case of emphysematous gastritis that worsened after endoscopy. Aeration during upper endoscopy examination can cause barotrauma to the gastric wall with impairment of the mucosal barrier, resulting in the spread of gastric wall infection to the whole body. Therefore, we report this case and provide relevant literature review to suggest that early endoscopic evaluation can lead to exacerbation of emphysematous gastritis.

A Rare Case of Syphilitic Myelitis of the Spinal Cord

김진혁,정희석,박찬규,류화성,노지은,염정아,김태언 대한자기공명의과학회 2019 Investigative Magnetic Resonance Imaging Vol.23 No.3

Neurosyphilis is an infection of the brain or spinal cord that is caused by the bacterium Treponema pallidum . Syphilitic myelitis, which involves the spinal cord, is a very rare form of neurosyphilis seen in patients with syphilis. It requires differentiation from other diseases of the spinal cord, including idiopathic transverse myelitis and spinal cord infarction. Herein, we describe the presentation and diagnosis of syphilitic myelitis in a 43-year-old woman, based on a flip-flop sign and candle guttering appearance depicted in magnetic resonance imaging and laboratory tests.