Software Development for the Integrated Visualization of Brain Tumor and its Surrounding Fiber Tracts

PURPOSE: The purpose of this study was to implement a software to visualize tumor and its surrounding fiber tracts simultaneously using diffusion tensor imaging and examine the feasibility of our software for investigating the influence of tumor on its surrounding fiber connectivity. MATERIALS AND METHODS: MR examination including T1-weigted and diffusion tensor images of a patient with brain tumor was performed on a 3.0 T MRI unit. We used the skull-striped brain and segmented tumor images for volume/surface rendering and anatomical information from contrast-enhanced T1-weighted images. Diffusion tensor images for the white matter fiber-tractography were acquired using a SE-EPI with a diffusion scheme of 25 directions. Fiber-tractography was performed using the streamline and tensorline methods. To correct a spatial mismatch between T1- weighted and diffusion tensor images, they were coregistered using a SPM. Our software was implemented under window-based PC system. RESULTS: We successfully implemented the integrated visualization of the fiber tracts with tube-like surfaces, cortical surface and the tumor with volume/surface renderings in a patient with brain tumor. CONCLUSION: Our result showed the feasibility of the integrated visualization of brain tumor and its surrounding fiber tracts. In addition, our implementation for integrated visualization can be utilized to navigate the brain for the quantitative analysis of fractional anisotropy to assess changes in the white matter tract integrity of edematic and peri-edematic regions in a number of tumor patients.

Age-Related Changes in Conventional and Magnetization Transfer MR Imaging in Elderly People: Comparison with Neurocognitive Performance

OBJECTIVE: This study was designed to compare three different measures of the elderly human brain; the magnetization transfer ratio (MTR) histogram, the percentage of brain parenchymal volume, and the volume of T2 hyperintense areas in terms of correlations with the study subjects' neurocognitive performance. MATERIALS AND METHODS: Thirty-five healthy community-dwelling elderly volunteers aged 60-82 years underwent dual fast spin-echo (FSE) imaging and magnetization transfer imaging. A semi-automated technique was used to generate the MTR histogram, the brain parenchymal volume, and the T2 lesion volume. The subjects' neurocognitive performance was assessed by using the Korean-Mini Mental State Examination (K-MMSE) and additional tests. The peak height of the MTR (PHMTR), the percentage of brain parenchymal volume (PBV), and the normalized T2 lesion volume (T2LV) were compared between the normal group (Z score on the K-MMSE > or = -2, n=23) and the mild cognitive impairment group (Z score on the K-MMSE < -2, n=12), and these parameters were correlated with age and various neurocognitive performance scores. RESULTS: The PHMTR was significantly lower in the cognitively impaired subjects than the PHMTR in the normal subjects (p = 0.005). The PBV scores were lower in the cognitively impaired subjects than in the normal subjects (p = 0.02). The T2LV scores were significantly higher in the cognitively impaired subjects (p = 0.01). An inverse correlation was found between the PHMTR and T2LV (r = -0.747, p < ; 0.001), and also between the PBV and T2LV (r = -0.823, p < ; 0.001). A positive correlation was observed between the PHMTR and the PBV (r = 0.846, p < 0.001). Scores on the various neurocognitive tests were positively correlated with the PHMTR (6 of 7 items) and the PBV (5 of 7 items), and they were negatively correlated with the T2LV (5 of 7 items). CONCLUSION: Our findings of a correlation among the PBV, the T2LV, and the PHMTR suggest that MTR histograms and the PBV and T2LV can be used as a reliable method and valid statistical tool, respectively, for quantifying the total lesion burden in an aging brain.

Clinical observation of patients with tsutsugamushi disease at Pyoungtaek area

BACKGROUND: The purpose of this stady is to define the clinical characteristics of Tsutsugamushi disease. METHODS: We analyzed 12 cases of tsutsugamushi disease admitted to BAG AE general hospital from 1999. Oct. 1st to Dec. 10. Tsutsugamushi disease was diagnosed by indirect immunofluorescent antibody test. RESULTS: 1) Among them, 8 cases were female and 4 cases were male. The prevalence was predominantly high in female. 2) The age distribution ranged from 40 to 80 years old. The high incidence of age was 70's and 80's. 3) The peak incidene was showed between October and November.(91.6%). 4) The most frequent symptoms were fever and chills(91.6%). 5) Rash and eschar were observed in 83.3%(10 of 12) both. 6) Hepatosplenomegaly and lymphadenopathy were also observed in 25%(3 of 12), 16.6%(2 of 12) respectively. 7) The Laboratory finding showed the elevation of AST 66.6% (8 of 12), ALT 58.3%(7 of 12), alkaline phosphatase 25%(3 of 12) and LDH 25%(3 of 12). Albuminuria and hypoalbuminuria were also observed in 25%(3 of 12), 58.3%(7 of 12) respectively. 8) The therapeutic efficacy of doxycycline was excellent. CONCLUSION: Tsutsugamushi disease which appeared in Pyoungtack area showed typical clinical pattern and was effective to doxycycline treatment.