Characterization of Cystic Breast Masses on Ultrasound: Comparative Study among Conventional, Tissue Harmonic, Compound, and a Combination of Tissue Harmonic and Compound Imaging

추지영,서보경,이안,김희영,조규란,우옥희,손길수,김백현 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.4

Purpose: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US)techniques including tissue harmonic, compound, and the combination of these techniques. Materials and Methods: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman’s test and receiver operating characteristic (ROC) analyses. Results: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). Conclusion: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.

Inflammatory Metastatic Carcinoma of Sternum Mimicking Sternal Osteomyelitis with Gas Gangrene

추지영,제보경,이기열,김백현,김성범 대한영상의학회 2013 대한영상의학회지 Vol.68 No.5

Inflammatory metastasis is a metastatic tumor associated with fever, skin changes, soft tissue inflammation, and laboratory abnormalities, suggesting an inflammation that obscures the underlying malignancy. We report a 69-year-old male with inflammatory metastatic carcinoma of sternum. He presented with clinical findings mimicking osteomyelitis of the sternum. The chest CT scan showed the parasternal soft tissue masses and cortical disruption of sternum which was continuous with air bubbles spreading through the pectoralis muscles. He was diagnosed as poorly-differentiated carcinoma with unknown origin.

Ultrasonographic Demonstration of the Tissue Microvasculature in Children: Microvascular Ultrasonography Versus Conventional Color Doppler Ultrasonography

유중현,제보경,추지영 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.2

Microvascular ultrasonographic imaging is the most recent and unique Doppler ultrasound technique. It uses an advanced clutter filter that can remove clutter artifacts and preserve the low-velocity microvascular flow signal. The potential advantages of microvascular ultrasonography are its superiority in detection and visualization of the small blood vessels in tissues, providing radiologists with more information on the vascular structures. Therefore, it has shown particular value in the clinical fields. The aim of this study was to provide microvascular ultrasonographic images for the tissue microvasculature, including the brain, thyroid gland, kidney, urinary bladder, small bowel, ovary, testis, lymph node, and hemangiomas in children, focusing on the comparison with conventional color Doppler ultrasonographic images.

흉부영상에서 보이는 정상 범위의 노인성 변화

강은영,이재욱,추지영,용환석,이기열,오유환 대한영상의학회 2017 대한영상의학회지 Vol.77 No.3

노인 흉부 X선 사진과 흉부 CT에서 보이는 전형적이고 흔한 정상 범위의 형태학적인 변화를 폐, 기도, 종격, 흉벽, 횡격막 순으로 분류하였다. 폐의 변화로는 폐포의 과다팽창, 폐기저부 중력의존부위 간유리음영, 모자이크양 음영, 기저부 흉막하폐야의 경미한 그물음영, 작은 폐결절, 작은 기낭, 폐첨부 모자 등이 있다. 기도의 변화로는 기관기관지벽 연골의 석회화, 기관 전후경의 증가, 기관지폐혈관비와 기관지벽 두께의 증가 등이 있다. 종격의 변화로는 심비대, 관상동맥 석회화, 심장 판막의 석회화, 대동맥확장과 혈관벽의 석화화, 지방의 과다 축적 등이 있다. 흉벽의 변화로는 근육량 감소, 골다공증, 늑골연골의 석회화, 흉벽 전후경의 증가 등이 있다. 횡격막의 변화로는 돌출된 형태, 횡격막 결손, 식도 열공을 통한 탈장 등이 있다. 노인 흉부 X선 사진과 흉부 CT에서 보이는 노화에 따른 형태학적인 변화를 인지하여 정상 범주의 변화와 치료가 필요한 질환을 구분하는 것은 흉부영상 판독에 있어 기본이고 필수이다. Many age-related morphologic changes are revealed in radiologic images of the chest in the elderly. We categorize the aging chest according to changes in the lung, airways, mediastinum, chest wall, and diaphragm. Changes in the lung include age-related alveolar hyperinflation, ground-glass opacity in basal dependent lungs, mosaic attenuation pattern, reticular densities in basal subpleural lungs, small nodule, air cyst, and apical cap. Changes in the airway include the tracheobronchial wall cartilage calcification, increased anterior-posterior diameter of the trachea, increased bronchoarterial ratio and bronchial wall thickness. Mediastinum changes include cardiac enlargement, coronary and cardiac valve/annulus calcification, aorta dilation and wall calcification, and excessive fat deposition. The chest wall shows decreased muscle mass, osteophytes, rib cartilage calcifications, and increased thoracic anterior-posterior diameter. The diaphragm changes include bulging contour, diaphragm defect, and esophageal hiatal hernia. Radiologists should therefore be aware of the age-related changes in the elderly chest. Differentiation between normal age-related changes and clinically significant disease is essential in the interpretation of chest radiologic images.

CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension

이녕근,박창민,강창현,전윤경,추지영,이현주,구진모 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.6

Objective: To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). Materials and Methods: From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. Results: All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. Conclusion: CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules. Objective: To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). Materials and Methods: From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. Results: All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. Conclusion: CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.

Endometrial Stromal Sarcoma Presented as an Incidental Lung Mass with Multiple Pulmonary Nodules

강동오,김제형,최수인,오지연,김재겸,최종현,추지영,황진욱,이승헌,이주한,이기열,신철 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.3

Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A 6.9×5.8 cm-sized intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.