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Biomedical subjects

Dong Ik Kim

Publications and source records attributed to Dong Ik Kim.

At least 19 recordsLinked to original sources

Corpus callosal connection mapping using cortical gray matter parcellation and DT-MRI.

Population maps of the corpus callosum (CC) and cortical lobe connections were generated by combining cortical gray matter parcellation with the diffusion tensor fiber tractography of individual subjects. This method is based on the fact that the cortical lobes of both hemispheres are interconnected by the corpus callosal fibers. T1-weighted structural MRIs and diffusion tensor MRIs (DT-MRI) of 22 right-handed, healthy subjects were used. Forty-seven cortical parcellations in the dorsal prefrontal cortex, ventral prefrontal cortex, sensory-motor cortex, parietal cortex, temporal cortex, and occipital cortex were semi-automatically derived from structural MRIs, registered to DT-MRI, and used to identify callosal fibers. The probabilistic connections to each cortex were mapped on entire mid-sagittal CC voxels that had anatomical homology between subjects as determined by spatial registration. According to the population maps of the callosal connections, the ventral prefrontal cortex and parts of the dorsal prefrontal cortex both project fibers through the genu and rostrum. The CC regions through which the superior frontal cortex passes extend into the posterior body. Fibers arising from the parietal lobe and occipital lobe run mainly through the splenium, while fibers arising from the sensory-motor cortex pass through the isthmus. In general, dorsal or medial cortical lobes project fibers through the dorsal region of the CC, while lateral cortical lobes project fibers through the ventral region of the CC. The probabilistic subdivision of the CC by connecting cortical gray matter provides a more precise understanding of the CC.

Brain Mapping↗

MR findings of fulminent leukoencephalopathy in EBV-associated hemophagocytic syndrome.

Various manifestations of brain involvement for patients with virus-associated hemophagocytic syndrome have been reported. Here, we report on the sequential magnetic resonance (MR) findings of acute demyelination of the entire brain with subsequent brain atrophy in a follow-up study of a 25-month- old boy who was admitted with fever and then diagnosed with infectious mononucleosis and EBV-associated hemophagocytic syndrome. We also review other conditions that should be included in the differential diagnosis of this disease.

Brain Diseases↗

Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients.

BACKGROUND AND PURPOSE: Recanalization rates after the intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment have been poorly studied in acute stroke. METHODS: CT angiography was performed before IV rt-PA in all patients and digital subtraction angiography was undertaken for intra-arterial thrombolysis in cases of no improvement after rt-PA infusion. RESULTS: Forty-five patients were treated with IV rt-PA. Initial CT angiography showed relevant arterial occlusions in 35 patients. Recanalization after rt-PA therapy was demonstrated by digital subtraction angiography in 7 of the 31 patients with the occlusion on initial CT angiography: 2/16 in the internal carotid or proximal middle cerebral artery, 3/11 in the distal middle cerebral artery and 2/4 in the basilar artery occlusion. CONCLUSIONS: The early recanalization rate after IV rt-PA use was very low in cases with large proximal arterial occlusions. CT angiography before IV rt-PA may be useful for the prediction of its efficacy.

Angiography, Digital Subtraction↗

Assessment of regional GABA(A) receptor binding using 18F-fluoroflumazenil positron emission tomography in spastic type cerebral palsy.

Periventricular leukomalacia (PVL) due to hypoxic-ischemic insult to the immature brain, chorioamnionitis and maternal infection are the major etiological factors of spastic type cerebral palsy (CP). Despite advances in preventing and treating certain causes of CP, the number of patients has remained essentially unchanged and the pathophysiological mechanisms related to motor dysfunction remain poorly understood. In this study, statistical parametric mapping (SPM) analysis of cerebral gamma-aminobutyric acid (GABA) receptor PET imaging using [18F]-fluoroflumazenil showed increased GABA(A) receptor binding in the bilateral motor and visual cortices in spastic diplegia (SD) type CP patients (n = 20) compared with normal controls (n = 10). As GABA(A) receptor signaling modulates biological perception and production of movement, complex motor skills and use-dependent plasticity in the motor cortex, increased GABA(A) receptor binding in the motor cortex might play a important role in poor motor control. Decreased GABA(A) receptor binding was seen in the brain stem in SD CP patients, which appears to be related to spastic symptom.

Adolescent↗

Diffusion-tensor magnetic resonance imaging in children with language impairment.

We evaluated the integrity of the white matter tract using diffusion-tensor magnetic resonance imaging in children with language impairments who exhibited a structurally normal brain on conventional magnetic resonance imaging, and compared it with age-matched normal children. After generating fractional anisotropy and color-coded vector maps, fractional anisotropy values of the major white matter tracts were measured in six locations and compared between the two groups. Compared with the normal control group, the fractional anisotropy values of children with language impairments showed a statistically significant reduction in the genu of the corpus callosum, which is rarely revealed on conventional magnetic resonance images. Our results suggest that delayed maturation of the white matter plays a partial role in the pathophysiological mechanisms of language impairments.

Anisotropy↗

Detection of thrombus in acute ischemic stroke: value of thin-section noncontrast-computed tomography.

BACKGROUND AND PURPOSE: Previous studies on the hyperdense middle cerebral artery (MCA) sign were conducted using > or =5-mm thickness noncontrast-computed tomography (NCT). The purpose of this study was to compare thin-section NCT with 5-mm NCT in the detection of thrombus in acute ischemic stroke. METHODS: Enrolled were consecutive 51 patients with acute infarction in the anterior or MCA territory. All patients underwent both 5-mm NCT and either 1.25- or 1-mm thin-section helical NCT within 6 hours of symptom onset. Patients were assigned to either the single or multisegmental occlusion group, depending on the thrombus extent on thin-section NCT. Thin-section NCT and 5-mm NCT were compared in the detection of thrombi. RESULTS: Thrombi were identified in 45 patients (88%) on thin-section NCT and 16 on 5-mm NCT (31%; P<0.001). No occlusion was seen in 6 patients. Both sensitivity and specificity of thin-section NCT in detection of thrombus were 100%. CONCLUSIONS: Acute thrombus can be detected with higher sensitivity on thin-section NCT than on 5-mm NCT, and its extent is more accurately determined on thin-section NCT.

Aged↗

Stent-assisted coil embolization of intracranial wide-necked aneurysms.

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent2 was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.

Adult↗

Rescue localized intra-arterial thrombolysis for hyperacute MCA ischemic stroke patients after early non-responsive intravenous tissue plasminogen activator therapy.

The outcome of patients who show no early response to intravenous (i.v.) tissue plasminogen activator (tPA) therapy is poor. The objective of this study was to evaluate the feasibility of rescue localized intra-arterial thrombolysis (LIT) therapy for acute ischemic stroke patients after an early non-responsive i.v. tPA therapy. Patients with proximal MCA occlusions who were treated by LIT (n = 10) after failure of early response [no improvement or improvement of National Institute of Health Stroke Scale (NIHSS) scores of < or = 3] to i.v. tPA therapy (0.9 mg/kg-10% bolus and 90% i.v. infusion over 60 min) were selected. The recanalization rates, incidence of post-thrombolysis hemorrhage and clinical outcomes [baseline and discharge NIHSS scores, mortality, 3 months Barthel index (BI) and modified Rankin score (mRS)] were evaluated. Rescue LIT therapy was performed on ten MCA occlusion patients (male:female = 3:7, mean age 71 years). The mean time between the initiation of i.v. tPA therapy and the initiation of intra-arterial urokinase (i.a. UK) was 117+/-25.0 min [time to i.v. tPA 137+/-32 min; time to digital subtraction angiography (DSA) 221+/-42 min; time to i.a. UK 260+/-46 min]. The baseline NIHSS scores showed significant improvement at discharge (median from 18 to 6). Symptomatic hemorrhage and, consequent, mortality were noted in 2/10 (20%) patients. Three months good outcome was noted in 4/10 (40%, mRS 0-2) and 3/10 (30%, BI > or = 95). In conclusion, rescue LIT therapy can be considered as a treatment option for patients not showing early response to full dose i.v. tPA therapy. Larger scale studies for further validation of this protocol may be necessary.

Aged↗

Multistage ethanol sclerotherapy of soft-tissue arteriovenous malformations: effect on pulmonary arterial pressure.

PURPOSE: To retrospectively investigate how repeat injections of absolute ethanol in therapeutic doses, required for multisession sclerotherapy of large high-flow soft-tissue arteriovenous malformations (AVMs) in patients with normal cardiopulmonary function, affect pulmonary arterial pressure (PAP). MATERIALS AND METHODS: Study received approval and waiver of informed consent by institutional review board and was conducted in 16 male and 16 female patients with AVMs who underwent repeat sclerotherapy (142 sessions total) with absolute ethanol from July 1997 to December 2003. PAPs were monitored during first session in all patients. In subsequent sessions, PAP was monitored with pulmonary catheter when predicted single dose of ethanol exceeded 3 mL and total amount exceeded 0.25 mL/kg. PAP was measured in 104 sessions. Serum ethanol levels from blood samples obtained at end of each session were reviewed. PAP parameters were analyzed at beginning and end of each session, and highest value was recorded to assess any increase after repeat therapy. Difference between initial and highest PAP values recorded in a session (Delta(max)) was noted to determine any increase during repeat sessions. Possible relationship was reviewed between this value and amount of ethanol used. For sessions without PAP monitoring, mixed model was used for statistical analysis. RESULTS: Total ethanol used was variable. In 43 sessions, highest mean PAP exceeded 25 mm Hg. Incidence of sustained pulmonary hypertension (mean PAP > 25 mm Hg) at end of each session was 30.8% (32 of 104 sessions). Initial PAP parameters did not increase or decrease during repeat sessions. No significant changes in Delta(max) of systolic and mean PAP were observed with increasing number of sessions. Rather, Delta(max) of diastolic PAP was reduced after repeat sessions (P = .03). There was no significant correlation between serum ethanol level and PAP parameters at end of sessions. Relationships between Delta(max) values of systolic, mean, and diastolic PAP and total ethanol used were not significant. CONCLUSION: High incidence of acute pulmonary hypertension was observed in each sclerotherapy session without lasting effect on PAP.

Adolescent↗

The usefulness of fractional anisotropy maps in localization of lacunar infarctions in striatum, internal capsule and thalamus.

We aimed in this study to assess the clinical usefulness of fractional anisotropy (FA) maps in the evaluation of lacunar infarctions in striatum, internal capsule and thalamus. We retrospectively reviewed 28 patients (18 men, 10 women; mean age 63 years) who had acute lacunar infarction in striatum, internal capsule and thalamus on diffusion weighted MR imaging (DWI). Fractional anisotropy (FA) maps were generated in addition to conventional T2 weighted images (T2WI) and trace maps of DWI. Two radiologists reviewed the location of infarcts in combination with and without FA maps. Exact location of infarction was determined by FA maps, i.e. on the white band of internal capsule or outside the internal capsule. Accuracy and inter-observer agreement on determination of the location of infarction was evaluated. Accuracy of infarct localization by T2WI-DWI only was varied from 72 to 91% according to the observers. Inter-observer agreement value was moderate (Kappa=0.446), when images were interpreted by T2WI-DWI only. Clinical manifestation of each lesions were varied, but sensory motor stroke was mainly observed in thalamic lesion (50%), while pure motor hemiparesis was predominant in the case of infarct involving internal capsule, corona radiata (91%) and basal ganglia (83%). The FA map is useful in the evaluation of lacunar lesions in striatum, internal capsule and thalamus. Clinical presentation varies according to the exact location of lacunar infarctions, and more accurate diagnosis can be made by FA maps as well as conventional T2-weighted image and DWI.

Acute Disease↗

Decreased fractional anisotropy of middle cerebellar peduncle in crossed cerebellar diaschisis: diffusion-tensor imaging-positron-emission tomography correlation study.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the clinical usefulness of diffusion tensor MR imaging (DTI) for the assessment of chronic stroke with crossed cerebellar diaschisis (CCD). METHODS: Twenty-two patients (15 men and 7 women; mean age, 60 years) with chronic stroke (13 ischemic and 9 hemorrhagic) were evaluated by diffusion-tensor MR imaging (DTI) and (18)F-fluorodeoxyglucose (FDG)-positron-emission tomography (PET). Fractional anisotropy (FA) and color-coded vector maps were generated. To evaluate afferent fiber systems to the cerebellum, the FA of the bilateral middle cerebellar peduncle (MCP) was measured. Changes of FA values in the MCP were compared against PET results. RESULTS: In patients with a chronic infarct involving more than one-third of the unilateral hemisphere, MCP of the contralesional side showed an FA value of 0.5226 +/- 0.0174, which was significantly lower than that of the ipsilesional side MCP (0.5366 +/- 0.0159) (one-tail paired t test, P = .0009). On FDG-PET scan, decreased glucose metabolism was observed in the affected cerebellum in 19 patients (86.4%). CONCLUSION: DTI can visualize an altered corticocerebellar circuit in the case of chronic stroke with CCD, which is hardly demonstrated by conventional MR images.

Adolescent↗

Diffusion tensor MRI visualizes decreased subcortical fiber connectivity in focal cortical dysplasia.

Diffusion tensor imaging (DTI) was applied to 12 patients with focal cortical dysplasia (FCD) in frontal or occipital cortex. Fiber tractography was obtained from seeding points in superior longitudinal fasciculus or posterior corona radiata. Mean fractional anisotropy of fiber bundles around the affected cortex was decreased in comparison to the contralateral hemisphere with statistical significance (paired t test, P = 0.0274). On visual analysis, tractography depicted decreased volume of fiber bundles connected to the dysplastic cortex invariably even in those with a normal T2 signal intensity of underlying white matter adjacent to FCD. DTI has high potential to be applied to localize the FCD and to provide a better understanding of the pathological changes in the white matter.

Adolescent↗

Diffusion tensor MR imaging visualizes the altered hemispheric fiber connection in callosal dysgenesis.

We report three cases of callosal dysgenesis that were evaluated by diffusion tensor imaging and fiber tractography. In partial agenesis of corpus callosum, fiber tracts from all regions of brain converged to a partially developed small genu portion and connected to the contralateral side. In complete callosal agenesis, fibers from the hemispheres failed to cross the midline and formed thick bundles running anteroposteriorly (eg, Probst bundle). The thickness of the anterior commissure was enlarged or smaller than normal brain, and other white matter tracts were not markedly different from normal brain tissue.

Abnormalities, Multiple↗

Reperfusion cellular injury in an animal model of transient ischemia.

BACKGROUND AND PURPOSE: Early thrombolytic therapy is encouraged in hyperacute stroke, although this might result in delayed reperfusion injury. Our purpose was to investigate the serial changes in cerebral perfusion following transient ischemia by means of MR imaging and to correlate them with the histologic findings obtained by using the TdT-mediated dUTP-biotin nick-end labeling (TUNEL) assay. METHODS: One-hour transient occlusion of the middle cerebral artery was produced in 10 cats. Serial perfusion-weighted MR imaging was performed for 3 days after reperfusion. The reperfusion characteristics in each region of the brain were classified into four groups according to the serial perfusion MR imaging status: normal perfusion (N), continuous hyperperfusion (I), early hyperperfusion and gradual decrease (II), and persistent hypoperfusion (III). After the last imaging session, a specimen was obtained, and TUNEL staining was performed. TUNEL-positive cells were counted under a high-power-field (HPF) light microscope (x200). The degree of TUNEL positivity was compared among the four reperfusion groups classified on the basis of serial perfusion-weighted imaging findings. RESULTS: Group N had 16.8 +/- 5.1 TUNEL-positive cells per HPF. Groups I and II had a statistically significant increase in TUNEL positivity (39.5 +/- 13.4 and 43.6 +/- 16.7 cells per HPF; P < .01, one-way analysis of variance), whereas group III had a statistically insignificant increase in TUNEL positivity (23.3 +/- 6.9 cells per HPF). CONCLUSION: Reperfusion followed by hyperperfusion induced cellular damage, although the initial MR imaging findings were normal. The inclusion of anti-reperfusion injury therapy should be considered in thrombolytic treatment.

Animals↗

Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke.

BACKGROUND AND PURPOSE: Combined intravenous (IV) and intra-arterial (IA) thrombolytic therapy may be faster and easier to initiate than monotherapy, and its recanalization rate may be better as well. The sequential combination of recombinant tissue plasminogen activator (rTPA) and urokinase (UK) has synergistic and complementary effects on clot lysis. We prospectively evaluated the effectiveness and safety of sequential combination of IV rTPA and IA UK in acute ischemic stroke. METHODS: IV rTPA was administered to patients with acute stroke within 3 hours of onset. Those whose condition had not improved at the end of rTPA infusion were further treated with selective IA UK. We evaluated baseline and 30-day National Institutes of Health Stroke Scale (NIHSS) scores and 90-day modified Rankin Scale scores. RESULTS: Thirty patients were initially treated with IV rTPA; 24 were further treated with IA UK. Four patients who had rapid reocclusion following initial successful IA therapy received IV abciximab. Fourteen of 24 patients who underwent angiography had an effective perfusion state of Thrombolysis in Myocardial Infarction grade 3 flow. Median baseline and 30-day NIHSS scores were 18 and 2, respectively. Eighteen patients improved to a modified Rankin scale score of 0 or 1 after 90 days. Symptomatic hemorrhage developed in two patients. CONCLUSION: The strategy of using conventional-dose IV rTPA and the sequential combination of IA UK in patients without an early clinical response to IV treatment was safe and feasible. This strategy achieved high complete arterial recanalization rates and good functional outcomes.

Abciximab↗

Homonymous hemianopia after embolization of an aneurysm-associated AVM supplied by the anterior choroidal artery.

The primary objective for the treatment of arteriovenous malformations (AVM) of the brain is to reduce the risk of hemorrhage. The risk of hemorrhage is known to increase with the presence of an aneurysm associated with AVM. The purpose of this report is to describe the development of visual complications after the embolization of a hemorrhagic anterior choroidal artery feeding AVM with an associated aneurysm and to describe the possible causes.

Adult↗