인공신경회로망을 이용한 뇌 F-18-FDG PET 자동 해석: 내,외측 측두엽간질의 감별

이재성 ( Jae Sung Lee ),이동수 ( Dong Soo Lee ),김석기 ( Seok Ki Kim ),박광석 ( Kwang Suk Park ),이상건 ( Sang Kun Lee ),정준기 ( June Key Chung ),이명철 ( Myung Chul Lee ) 대한핵의학회 2004 핵의학 분자영상 Vol.38 No.3

목적: 내,외측 측두엽간질의 감별은 중요하고 F-18-FDG PET이 도움을 주나 성능이 아주 우수하지는 않다. 이 연구에서는 수술과 수술 후 추적 병리소견으로 확진한 내측성 또는 외측성 측두엽간질 환자의 F-18-FDG PET영상을 후향적으로 조사하여 내측 및 외측 측두엽 대사 감소 양상을 추출하고 내측성과 외측성 간질을 감별하기 위한 인공신경회로망을 이용한 감별시스템을 개발하였으며 판독 성능을 핵의학전문가와 비교하였다. 대상 및 방법: 수술로 확진한 Purpose: We developed a computer-aided classifier using artificial neural network (ANN) to discriminate the cerebral metabolic pattern of medial and lateral temporal lobe epilepsy (TLE). Materials and Methods: We studied brain F-18-FDG PET images of 113 e

난치성 간질환자에서 간질관련요인이 발작간 정신증상에 미치는 영향

김종훈,한우상,이상건,류인균,하규섭,Kim, Jong-Hoon,Han, Wou-Sang,Lee, Sang-Kun,Lyoo, In-Kyoon,Ha, Kyoo-Seob 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

The aim of this study is to find the relationship between interictal psychiatric symptoms and seizure-related variables such as structural changes, regional interictal perfusion changes, the number of interictal epileptic discharges and the presence of accompanying generalized tonic clonic seizure(GTC). The subjects were 75 patients (47 males : mean age $28.3{\pm}7.7$) with intractable epilepsy, Interictal psychiatric symptoms were rated by Symptom Checklist-90-R(SCL-90-R). Each of 4 seizure variables was measured by MRI, $^{99m}TC-HMPAO$ SPECT and the prolonged EEG monitoring. The mean SCL-90-R subscale T-scores and the ratio of the patients with definite psychiatric symptoms(T-score > 65 at any one subscale of SCL-90-R) were compared among the groups with different seizure variables. Demographic variables and clinical variables were not statistically different among the groups with different seizure variables. The patients with right mesial temporal sclerosis had higher mean SCL-90-R scores for obsessive compulsive symptom, interpersonal sensitivity, depression, hostility and psychotic symptoms than the patients with left mesial temporal sclerosis, and they also showed higher ratio of definite psychiatric symptoms. The presence of interictal epileptic discharges was related with higher T-scores of paranoid subscale. The areas of hypoperfusion, the presence of the GTC, and other clinical seizure variables showed no significant influences on the mean SCL-90-R subscale T-scores. from these results, the authors speculated that interictal subictal epileptic dischrages may be related with psychiatric symptoms of the intractable epileptic patients, especially with right mesial temporal sclerosis.

H2 15O 양전자단층촬영술을 이용한 뇌기능 지도 작성 ( II ) - 작업 기억의 지도 작성

이재성,이동수,이상건,남현우,김석기,박광석,정재민,정준기,이명철 ( Jae Sung Lee,Dong Soo Lee,Sang Kun Lee,Hyun Woo Nam,Seok Ki Kim,Kwang Suk Park,Jae Min Jeong,June Key Chung,Myung Chul Lee ) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.3

Purpose: To localize and compare the neural basis of verbal and visual human working memory, we erforrned functional activation study using H2O PET. Materials and MethoDs: Repeated H213O PET scans with one control and three different activation tasks were performed on six right-handed narmal volunteers. Each activation task was composed of 13 matching trials. On each trial, four targets, a fixation dot and a probe were presented sequentially and subjects task was to press a response button to indicate whether or nat the probe was one of the previous targets. Short meaningful Korean words, simple drawings and monochromic pictures of human faces were used as matching objects for verbal or visual memory. All the images were spatially normalized and the differences between control and activation states were statistically analyzed using SPM96. Results: Statistical analysis of verbal memory activation with short words showed activation in the left Broca's area, premotor cortex, cerebellum and right cingulate gyrus. In verbal memory with simple drawings, activation was shown in the larger regions including where activated with short words and left superior temporal cortex, basal ganglia, thalamus, prefrontal cortex, anterior portion of right superior temporal gyrus and right infero-lateral frontal cortex. On the other hand, the visual memory task activated predominantly right-sided structures, especially inferior frontal cortex, supplementary motor cortex and superior parietal cortex. Conclusion: The results are :consistent with the hypothesis of the laterality and dissociation of the verbal and visual workmg memory from the invasive electrophysiological studies and emphasize the pivotal role of frontal cortex and cingulate gyrus in working memory system. (Korean J Nucl Med 1998;32:238-49)

난치성 간질환자의 간질초점 위치와 정신증상과의 관련성

한우상,김종훈,이상건,조두영,권준수,하규섭,Han, Wou-Sang,Kim, Jong-Hoon,Lee, Sang-Kun,Cho, Doo-Young,Kwon, Jun-Soo,Ha, Kyoo-Seob 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

The prevalence rate of psychiatric symptoms of the refractory epileptic patients was evaluated according to the location of the epileptic focus. The subjects were 91 patients admitted to Epilepsy Monitoring Unit of Seoul National University Hospital. The psychiatric symptoms were assessed by Korean version of Symptom Checklist-90-R(SCL-90-R). The locus of epileptic focus was assessed by clinical features, 2-hour interictal EEG, long-term video-EEG monitoring, brain MRI, interictal and ictal brain SPECT, and interictal brain PET The subjects were divided into three groups according to the epileptic focus, non-temporal(N=29), left temporal (N=26), and right temporal(N=32). There were no statistical differences in demographic and seizure-related variables among groups. The number of patients with $T-score {\geq} 65$ at any subscale of the SCL-90-R were compared by $X^2-test$ among groups. The mean T-scores of each subscale of the SCL-90-R were compared by oneway-ANOVA among groups. The prevalence rate of psychiatric symptoms of the refractory epileptic patients was 38.5%. There was no statistical difference in the prevalence rate of psychiatric symptoms among groups. However, the patients with non-temporal or right temporal epileptic foci showed statistically significant higher mean T-scores of interpersonal sensitivity, depression, hostility, and phobic subscales than the patients with left temporal epileptic foci. These results suggest that the epileptic focus plays an important role in the production of interictal psychiatric symptoms of the refractory epileptics.

발작기와 발작간기 뇌 관류 SPECT 감산영상을 이용한 간질원인 병소 진단

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이상건(Sang Kun Lee),서종모(Jong Mo Seo),이재성(Jae Sung Lee),김현집(Hyun Jip Kim) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.1

N/A A robust algorithm to disclose and display the difference of ictal and interictal perfusion may facilitate the detection of ictal hyperfusion foci. Diagnostic performance of localizing epileptogenic zones with subtracted SPECT images was compared with the visual diagnosis using ictal and interictal SPECT, MR, or PET. Ictal and interictal Tc-99m-HMPAO cerebral perfusion SPECT images of 48 patients(pts) were processed to get parametric subtracted images. Epileptogenic foci of all pts were diagnosed by seizure free state after resection of epileptogenic zones. In subtraction SPECT, we used normalized difference ratio of pixel counts((ictal-interictal)/interictal×100%) after correcting coordinates of ictal and interictal SPECT in semi-automatized 3-dimensional fashion. We found epileptogenic zones in subtraction SPECT and compared the performance with visual diagnosis of ictal and interictal SPECT, MR and PET using post-surgical diagnosis as gold standard. The concordance of subtraction SPECT and ictal-interictal SPECT was moderately good(kappa=0.49). The sensitivity of ictal-interictal SPECT was 73% and that of subtraction SPECT 58%. Positive predictive value of ictal-interictal SPECT was 76% and that of subtraction SPECT was 64%. There was no statistical difference between sensitivity or positive predictive values of subtraction SPECT and ictal-interictal SPECT, MR or PET. Such was also the case when we divided patients into temporal lobe epilepsy and neocortical epilepsy. We conclude that subtraction SPECT we produced had equivalent diagnostic performance compared with ictal-interictal SPECT in localizing epileptogenic zones. Additional value of these subtraction SPECT in clinical interpretation of ictal and interictal SPECT should be further evaluated.

신피질성 간질에서 발작기 99mTc - HMPAO 뇌혈류 SPECT의 간질병소 국소화 성능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),김은실(Eun Sil Kim),현인영(In Young Hyun),장기현(Kee Hyun Chang),이상건(Sang Kun Lee) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.4

N/A The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography (sEEG). Ictal Tc-99m-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewd. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MR1, ictal SPECT found zones of hyperperfusion concordant with ictal sEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

내측 측두엽 간질환자와 정상인의 H215O PET 을 이용한 뇌 혈류량 비교

강은주(Eun Joo Kang),이재성(Jae Sung Lee),남현우(Hyun Woo Nam),이상건(Sang Kun Lee),이동수(Dong Soo Lee),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.3

목적: 본 연구는 내측 축두엽 간질 환자가 국소 혈류 변화를 보이는 두뇌 영역을 H_2^15O-PET를 이용하여 확인하는 것을 목적으로 하였다. 대상 및 방법: 12명의 내측두엽간질 환자 (우측 6명, 좌측 6명)와 6명의 정상인에게 `+` 응시 조건과, 위로 향한 화살표에만 단추를 눌러 반응하는 감각-운동 과제를 수행하면서 H_2^15O-PET을 실시하였다. 각 스캔의 영상 과 SPM99 소프트웨어를 이용하여 화소 분석방법으로 정상인과 환자 집단 사이에 기저 뇌혈류 또는 뇌혈류 증가 정도의 차이를 조사하였다. 결과: 응시기저 조건중에는 우 내측두엽 간질 환자는 좌우 양반구이 후측 도와 오른쪽 전두말단 부분의 혈류가 감소하였다. 같은 조건에서. 좌 내측두엽 간질 환자에서는 왼쪽 전두말단 영역과 측두엽 영역의 혈류가 정상인들보다 감소되었다. 응시조건과 비교하여 감각-운동 과제 중에 혈류가 증가하는 정도를 정상인과 비교하였을 때 우 내측두엽 간질 환자에게서는 왼쪽의 전두엽과 상측두 영역이, 좌 내측두엽 간질 환자들에게서는 우반구의 여러 영역이 저하되었다. 반면 두 환자 집단 모두 왼쪽의 하 두정엽과 전시상핵/뇌궁 연접 영역의 혈류 증가 정도가 정상인집단에 비하여 증가되었다. 결론: H_2^15O-PET으로 측정된 두뇌 국소 혈류 분포를 SPM99을 이용하여 분석함으로써, 단순한 감각 운동 조건 동안의 두뇌 국소 혈류 증가 양상은 물론이고, 응시점을 주시하는 단순 기저 조건 중 측정된 두뇌의 국소 혈류량의 분포에도 내측 간질 환자 집단과 정상인 집단간에 유의미한 차이가 있음이 발견되었다. Purpose: The aim of this study was to identify the brain areas whose regional cerebral blood flow (rCBF) was changed in medial temporal lobe epilepsy (mTLE) using H_2^15O-PET. Materials and Methods: 12 patients with mTLE (6 left, 6 right mTLE) and 6 normal controls were scanned during a fixation baseline period and a sensory-motor condition where subjects pressed a button to an upward arrow. A voxel-bassed analysis using SPM99 software was performed to compare the patient groups with the normal controls for the rCBF during fixation baseline period and for relative changes of rCBF during the sensory-motor task relative to fixation. Results: During the fixation baseline, a significant reduction of rCBF was found posterior insula bilaterally and right frontopolar regions in right mTLE patients compared to the nomal controls. In left mTLE patients, the reduction was found in left frontopolar and temporal regions. During the sensory-motor task,rCBF increase over the fixation period, was reduced in left frontal and superior temporal regions in the right mTLE patients whereas in various areas of right hemisphere in left mTLE patients, relative to normal controls. However, the increased rCBF was also found in left inferior parietal and anterior thalamic/fornix region in both right and left mTLE patients compared to normal controls. Conclusion: Epolepsy induced changes were found not only in relative increase/decrease of rCBF during a simple sensory-motor control condition relative to a fixation rest condition but also in the realtive rCBF distribution during the rest period. (Korean J Nucl Med 2002;36;155-65)

측두엽 간질에성 발작기 뇌관류 SPECT의 간질병소 국소화 성능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),김은실(Eun Sil Kim),장기현(Kee Hyun Chang),이상건(Sang Kun Lee),정천기(Chun Kee Chung) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.3

N/A Anterior temporal lobectomy has become a widely used resective surgery in patients with medically intractable temporal lobe epilepsies. Prerequisites of this resection include the accurate localization of the epileptogenic focus and the determination that the proposed resection would not result in unacceptable postoperative memory or language deficits. The purpose of this study was to evaluate the performance of ictal SPECT compared to MRI findings for localization of epiletogenic foci in this group of patients. 11 patients who had been anterior temporal oral lobectomy were evaluated with ictal 99m-Tc-HMPAO SPECT and MRI. MRI showed 8/11(73%) concordant lesion to the side of surgery and ictal SPECT also showed 8/11(73%) concordant hyperperfusion. In 3 cases with incorrect or nonlocalizing findings of MRI, ictal SPECT showed concordant hyperperfusion. In 2 cases confirmed by pre-resectional invasive EEG, MRI showed bilateral and contralateral lesion but ictal SPECT showed concordant hyperperfusion. 3 delayed injection of ictal SPECT showed discordant hyperperfusion. Thus, ictal SPECT was a useful method for localizing epileptogenic foci in temporal lobe epilepsies and appeared complementay to MRI.

전두엽 간질에서 F - 18 - FDG PET 의 간질병소 국소화 성능 ; 육안 판독과 SPM 에 의한 분석

김유경(Yu Kyeong Kim),이동수(Dong Soo Lee),이상건(Sang Kun Lee),정천기(Chun Kee Chung),여정석(Jeong Seok Yeo),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.3

N/A Purpose: We evaluated the sensitivity of the F-18 FDG PET by visual assessment and statistical parametric mapping (SPM) analysis for the localization of the epileptogenic zones in frontal lobe epilepsy. Materials and Methods: Twenty-four patients with frontal lobe epilepsy were examined. All patients exhibited improvements after surgical resection (Engel class I or II). Upon pathological examination, 18 patients revealed cortical dysplasia, 4 patients revealed tumor, and 2 patients revealed cortical scar. The hypometabolic lesions were found in F-18 FDG PET by visual assessment and SPM analysis. On SPM analysis, cutoff threshold was changed. Results: MRI showed structural lesions in 12 patients and normal results in the remaining 12. F-18 FDG PET correctly localized epileptogenic zones in 13 patients (54%) by visual assessment. Sensitivity of F-18 FDG PET in MR-negative patients (50%) was similar to that in MR-positive patients (67%). On SPM analysis, sensitivity decreased according to the decrease of p value. Using uncorrected p value of 0.05 as threshold, sensitivity of SPM analysis was 63%, which was not statistically different from that of visual assessment. Conclusion: F-18 FDG PET was sensitive in finding epileptogenic zones by revealing hypometabolic areas even in MR-negative patients with frontal lobe epilepsy as well as in MR-positive patients. SPM analysis showed comparable sensitivity to visual assessment and could be used as an aid in the diagnosis of epileptogenic zones in frontal lobe epilepsy. (Korean J Nucl Med 200135:131-141)

중등도 이상의 위험 수술을 받은 환자에서 수술 전후 항혈전제 약물 사용 평가

이현아,조윤희,조윤숙,한현주,이주연,정근화,이상건,Lee, Hyeon-Ah,Jo, Yun Hee,Cho, Yoonsook,Hahn, Hyeon Joo,Lee, Ju-Yeun,Jung, Keun-Hwa,Lee, Sang Kun 한국임상약학회 2017 한국임상약학회지 Vol.27 No.1

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.