Coil-Protected Embolization Technique for a Branch-Incorporated Aneurysm

인연권,김병문,서상현,김동준,김동익 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.2

Objective: A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm. Materials and Methods: Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated. Results: All aneurysms were successfully treated without any complications during the procedure. Immediate posttreatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment. Conclusion: In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms.

확산강조영상을 이용한 다양한 두개내 낭성병변 감별 진단의 유용성

인연권,전정수,황성수,백준현,박영하 대한영상의학회 2004 대한영상의학회지 Vol.50 No.6

Purpose: The purpose of this study was to evaluate the usefulness of diffusion-weighted imaging (DWI) for the differential diagnosis of various intracranial cystic lesions. Materials and Methods: This study included 19 patients (13 males, 6 females) with a mean age of 42.5 years. The final histopathological diagnoses for 14 patients were pyogenic brain abscess (n=3), glioblastoma (n=3), ependymoma (n=1), anaplastic astrocytoma (n=1), pilocytic astrocytoma (n=1), hemangioblastoma (n=2), arachnoid cyst (n=1), epidermoid (n=1) and schwannoma (n=1). The other cases of metastasis (n=4) and arachnoid cyst (n=2) were diagnosed on the basis of clinical, laboratory and imaging data. DWI imaging studies were performed with a 1.5 T MR system. A single shot spin echo EPI pulse sequence was applied. B values were set at 0 and 1000 sec/mm2. The apparent diffusion coefficient (ADC) were calculated from the ADC map of 10 different cystic brain lesions. Conventional MR imaging included T2WI, T1WI, FLAIR and contrast enhanced T1WI. We analyzed the location, nature, signal intensity on DWI, and the enhancement pattern of the lesions. Results: All of the 3 cases of brain abscess, 1 of 4 cases of metastasis and 1 case of epidermoid showed hyperintensity on DWI. The mean ADC value of brain abscess (2 cases) was less than 1.15 (0.13×10-3 mm2/s). The mean ADC values of the other cystic lesions (8 cases) were variable, ranging from 2.840.66 to 3.100.16 (10-3 mm2/sec). Conclusion: DWI and ADC values were useful in the differential diagnosis of various intracranial cystic lesions, but some metastatic tumors may mimic a brain abscess on DWI. Therefore, a clinical correlation is mandatory. 목적: 두개내의 존재하는 다양한 낭성 병변의 감별진단에 있어 확산강조영상의 유용성에 대해 알아보고자 한다. 대상과 방법: 두개강내 낭성병변으로 확산강조영상을 시행한 총 19명의 환자(남: 여=12:7, 평 균나이 43.9세)를 대상으로 하였다. 조직학적으로 진단된 14명중 뇌농양 3예, 교모세포종 3예, 상의세포종 1예, 역형성성상세포종 1예, 모양성 성상세포종 1예, 혈관모세포종 2예, 거미막낭 1 예, 표피양낭 1예, 신경초종 1예 이었다. 5명의 환자는 임상 및 혈액검사, 영상소견을 바탕 으로 전이암 4예, 거미막낭 1예로 진단하였다. 확산강조영상은 1.5 T 자기 공명 영상 장치를 이용, single shot spin echo EPI 펄스열을 사용하고, 두개의 다른 b value로(0, 1000) 확산경 사자계를 가한 다음 확산 강조영상을 획득하였다. 낭성병변 10예에서 얻은 겉보기 확산 지도 를 이용하여 겉보기 확산 계수를 구하였다. 추가적으로 T1 및 T2 강조영상, FLAIR 및 조영증 강 후 T1강조 영상을 얻은 후 병변의 위치 및 다발성 여부, 낭성 부위의 신호강도 및 조영증 강 양상을 분석하였다. 결과: 뇌농양은 3예 모두, 낭성 뇌종양은 1예의 전이암, 1예의 표피양낭이 확산 강조 영상에서 고신호강도를 보였다. 평균 겉보기 확산 계수치는 뇌농양(2예)의 경우 1.15±0.13(10-3 mm2/s) 이하였고, 그 외 낭성병변(8예)은 2.84±0.66 에서 3.10±0.16(10-3 mm2/sec)로 다양하였다. 결론: 확산강조영상과 겉보기 확산 계수는 뇌농양과 낭성, 괴사성 종양의 감별에 매우 유용하 다. 하지만 일부 전이암의 경우 뇌농양과 비슷한 신호 강도를 보일 수 있으므로 환자의 임상상 을 고려하여 감별진단 하여야 한다.

Isolated Oculomotor Nerve Palsy Caused by Cavernous Sinus Dural Arteriovenous Fistula: Case Report

인연권,정원상,김범수 대한영상의학회 2012 대한영상의학회지 Vol.67 No.4

Cavernous dural arteriovenous fistula (DAVF), which usually presents with conjunctival injection, proptosis, loss of visual acuity, and ophthalmoplegia, is a rare cause of ophthalmoplegia. Thus, it may be overlooked when the typical symptoms are lacking. There have been some cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We report a patient presenting with isolated oculomotor palsy, caused by cavernous DAVF, which was treated by transvenous coil embolization. This case suggests that cavernous DAVF should be considered in the differential diagnosis of isolated oculomotor nerve palsy and for which case - selective angiography and embolization may be helpful in reaching a diagnosis and providing a guide for optimal treatment.

Acute Marchiafava-Bignami Disease: Diffusion-Weighted MRI in Cortical and Callosal Involvement

인연권,황성수,박영하 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.2

Marchiafava-Bignami disease (MBD) is a fatal disorder characterized by demyelination of the corpus callosum. MRI, suggestive of corpus callosum demyelination with associated white matter involvement in both cerebral hemispheres, indicates a diagnosis of MBD. In this case, MR diffusion-weighted findings taken at an acute stage of MBD revealed lesions not only in the corpus callosum but also in the cerebral cortex. Lower apparent diffusion coefficient values of the corpus callosum and cortical lesions were associated with poor clinical outcome.

위절제술후 발생한 드문 뇌 지방색전증: 증례 보고

인연권,백준현 대한영상의학회 2004 대한영상의학회지 Vol.51 No.6

Cerebral fat embolism syndrome is a rare complication of trauma, and it particularly involves fractures of the long bones. This syndrome may occur in a diverse series of conditions such as diabetes mellitus, acute hemorrhagic pancreatitis, acute fatty cirrhosis, prolonged corticosteroid therapy, lymphography and liposuction. The author reports the CT and MRI findings in a patient with cerebral fat embolism that occurred as a rare complication of postgastrectomy. 뇌 지방색전증은 외상, 특히 장골골절 후 발생하는 드문 합병증이다. 외상이외의 다른 원인 으로 당뇨, 급성 출혈성 췌장염, 급성 지방성 간경변증, 장기간의 스테로이드 사용, 림프관 조 영술 및 지방흡인술 후에도 보고된 바 있다. 저자는 조기위암으로 아전위절제술을 시행 받은 환자에게서 발생한 드문 뇌 지방색전증의 CT 및 자기공명 영상소견 1예를 보고하고자 한다.

Ruptured Dissecting Aneurysm of the Middle Cerebral Artery with Spontaneous Resolution: A Case Report

인연권,정원상 대한영상의학회 2011 대한영상의학회지 Vol.65 No.5

Dissecting aneurysms of the middle cerebral artery (MCA) are known to cause cerebral infarcts in younger people and can also cause subarachnoid hemorrhage (SAH) or intracranial hemorrhage. Bleeding caused by an isolated dissecting aneurysm of the MCA is relatively rare. We report the case of a young woman with SAH that occurred subsequent to a ruptured dissecting aneurysm of the MCA which resolved spontaneously as demonstrated by angiography.

확산강조영상을 이용한 화농성 뇌실염 진단의 중요성

인연권,황성수,김태유 대한영상의학회 2007 대한영상의학회지 Vol.57 No.2

목적: 화농성 뇌실염 진단에서 뇌실 내 염증성 병변에 대한 확산강조영상의 소견과 중요성에 대해 알아보고자 하였다. 대상과 방법: 2004년 2월부터 2007년 2월까지 임상증상 및 확산강조영상에서 화농성 뇌실염으로 진단된 환자 9명의 영상소견을 후향적으로 분석하였다. 확산강조영상은 1.5 T MRI를 이용, single shot spin echo EPI 펄스열을 사용하고, 두개의 다른 b value로 (0, 1000 s/mm2) 확산경사자계를 가한 후 영상을 얻었다. 확산강조영상을 토대로 얻은 현성 확산 지도를 이용하여 뇌실 내 염증성 병변에 대한 현성 확산 계수를 구하였다. 추가로 T1 및 T2 강조영상, FLAIR 및 조영증강 후 T1 강조 영상을 얻었다. 얻어진 영상에서 뇌실내 염증성 병변의 유무 및 신호강도, 뇌실주변 백질의 신호강도, 수두증의 유무, 뇌실막의 조영증강 양상을 평가하였다. 결과: 뇌실내 염증성 병변은 확산강조영상에서 고신호강도를 보였다. FLAIR, T2 강조영상에서 뇌실주변 백질의 고신호 강도가 모든 환자에서 보였고, 8명(89%)에서 뇌실막의 조영증강이 있었으며, 6명(67%)에서 수두증이 보였다. 평균 현성 확산 계수치는 염증성 병변은 0.735±0.117(10-3mm2/sec) 이었고, 뇌피질 내 회질은 1.052±0.149(10-3 mm2/sec)로 통계적으로 의미있는 차이를 보였다. 결론: 뇌실 내 염증성 병변은 확산강조영상에서 고신호 강도, 현성 확산 계수 측정에서 확산제한을 보여 화농성 뇌실염 진단에 유용한 검사법으로 생각된다. Purpose: To evaluate the significance of diffusion weighted imaging (DWI) for the diagnosis of pyogenic ventriculitis. Materials and Methods: In this retrospective study, 9 patients with pyogenic ventricultis underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, FLAIR and enhanced T1 weighted imaging. DWI consisted of an axial single shot spin echo EPI pulse sequence with b values of 0 and 1000 sec/mm2. We evaluated the presence and signal intensity of ventricular debris, hydrocephalus, periventricular signal abnormality, and ependymal enhancement. The apparent diffusion coffiecient values of ventricular debris and cortical gray matter were calculated from the ADC map. Results: In all patients, ventricular debris was hyperintense on the DWIs. A periventricular hyperintense signal was present in all cases on FLAIR and T2WI. Ependymal enhancement was detected in eight (89%) of 9 cases. A hydrocephalus was observed in 6 (67%) of 9 cases. The mean ADC value of ventricular debris was 0.735 ± 0.117 (10-3 mm2/sec). These ADC values were significantly lower than those for cortical gray matter (1.052 ± 0.149 (10-3mm2/sec)). Conclusion: Ventricular debris was most conspicuous finding of ventriculitis on DWI. Areas of intraventricular hyperintensity on DWI corresponded to the decreased ADC values.

선천성 피부동로를 통한 척수내 경막하농양: 증례 보고

김봄이,인연권,정원상 대한영상의학회 2011 대한영상의학회지 Vol.64 No.3

Dermal sinus tracts are remnants of incomplete neural tube closure. Dermal sinus tracts in the spine range from asymptomatic pits to tracts with significant disease. Congenital spinal dermal sinus tract can produce significant morbidity if not adequately managed. Spinal subdural abscess caused by the spread of an infection within the dermal sinus tract is rare in children. We now described a 3-year-old male who presented with extensive spinal subdural abscess resulting from dermal sinus tract that was low-lying in the sacral area. 소아에서 발생하는 척수강 내 농양은 드물게 선천성 피부동로를 통해 감염이 파급되어 발생하는 질환으로 전 세계적으로 산발적인 증례보고가 있으며, 초기 진단 후 적절한 수술적 치료가 환자의 신경학적 예후에 중요하다고 알려져 있다. 저자들은 3세 남아에서 발생한 피부동로를 통한 척수 내 경막하농양 1예를 경험하였기에, 특징적인 영상소견을 보고하는 바이다.

Diffuse Hepatic Hemangiomatosis without Extrahepatic Involvement in an Adult Patient

김은희,박수연,인연권,황성수 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.6

We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma. We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma.

The Diagnostic Performance of Acoustic Radiation Force Impulse Elasticity Imaging to Differentiate Malignant from Benign Thyroid Nodules: Comparison with Conventional B-Mode Sonographic Findings

정원상,안영이,인연권,박영하 대한영상의학회 2016 대한영상의학회지 Vol.74 No.2

Purpose: The purpose of this study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) elasticity imaging. Materials and Methods: One hundred and twenty-seven thyroid nodules were examined by both ARFI elastography and B-mode sonography. Virtual Touch tissue quantification (VTQ) values of the thyroid nodules were measured. Scoring of B-mode sonographic findings of each thyroid nodules was performed. The sums of these VTQ and the B-mode scores were determined. The comparative diagnostic performances of the VTQ value, the B-mode score, and the combined score were analyzed. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each scoring mode were: B-mode score, 84%, 85%, 66%, 94%, and 85%; VTQ, 75%, 91%, 73%, 92%, and 86%; and combined score, 88%, 87%, 70%, 95%, and 88%. The areas under the curves for B-mode, VTQ, and combined score were 0.895, 0.837, and 0.912, respectively. Pairwise comparisons of receiver-operating characteristic curves showed no statistical differences between B-mode and VTQ, and B-mode and combined score. Combined score showed better diagnostic performance than VTQ value (p = 0.0023). Conclusion: ARFI VTQ value is a good diagnostic modality for differentiating malignant thyroid nodules from benign nodules. However, ARFI evaluation is not superior to B-mode sonographic evaluation, but only has a better diagnostic performance when combined with B-mode sonographic findings.