폐암과 폐 염증성질환의 동적양전자방출단층검사(Dynamic 18F-FDG PET)의 유용성

박훈희(Hoon-Hee Park),노동욱(Dong-Wook Roh),김세영(Sei-Young Kim),동경래(Dong-Kyeong Rae),이민혜(Min-Hye Lee),강천구(Chun-Goo Kang),임한상(Han-Sang Lim),오기백(Ki-Back Oh),김재삼(Jae-Sam Kim),이창호(Chang-Ho Lee) 대한방사선과학회(구 대한방사선기술학회) 2006 방사선기술과학 Vol.29 No.4

  목적: 양전자방출단층검사(Fluorine-18 2-Deoxy-D-Glucose positron emission tomography: ¹?F-FDG PET)는 가시적 영상분석과 반정량적 섭취계수 분석 방법을 사용하여 폐의 염증성 질환과 폐암을 구별 및 진단하는 데 유용하다. 일반적으로 표준화섭취계수(Standardized Uptake Value: SUV)가 폐 질환의 진단에 사용되지만, 이는 폐 조직에 있어서 반정량적, 정량적 분석을 통한 동적인 정보를 포함하지 않는다. 그러므로, 본 연구는 ¹?F-FDG PET 검사에서 폐 질환의 동적 섭취 분석이 보다 정확한 대상질환의 진단을 유용하게 할 수 있을 것이라는 가정하에 시간-방사능 곡선(Time-Activity Curve: TAC), 표준화섭취계수-동적곡선(Standardized Uptake Value-Dynamic Curve: SUV-DC), 패트락 분석법(Patlak analysis: Glucose Metabolic Rate(MRGlu))을 토대로 얻은 분석방법을 이용하여 진단적 유용성을 평가하였다.<BR>  대상 및 방법: 폐 질환을 가진 17명의 환자를 대상을 하여, 각각 60분간 Dynamic ¹?F-FDG PET검사를 시행하였다. 획득한 정보를 통하여 폐질환의 형태를 따라 관심영역(Region of Interest: ROI)를 그린 후, 반정량적 분석인 TAC, SUV-DC와 정량적 분석인 Patlak analysis를 각각의 군에 따라 분석하여 비교 분석하였다.<BR>  결과: Dynamic ¹?F-FDG PET을 통한 분석결과, TAC 형태는 초기 혈류상에서 폐의 염증성 질환과 폐암의 구분이 어려웠으나, 시간이 지날수록 폐암의 곡선이 염증성 질환의 경우보다 확연히 증가하였다. SUV-DC의 경우는 TAC 형태와 거의 유사한 형태를 가졌다. Patlak analysis 분석결과, 대동맥 영역에서는 폐의 염증성 질환이 폐암보다 높은 혈액 방사능을 보였으나 시간이 지남에 따라 염증성 질환의 혈액 방사능이 극히 낮아졌다. 반면, 병변 조직에서는 폐암이 가장 높은 섭취를 보였으며 폐의 염증성 질환은 중간 정도에 머물렀다.<BR>  결론: TAC와 SUV-DC 분석에서 폐암과 폐의 염증성 질환은 각각 고유한 그래프 형태를 띠었으며 Patlak analysis에서 역시 주목할 만한 차이를 보였다. 따라서 이러한 분석법을 토대로 좀더 깊이 있는 연구가 진행된다면 비침습적으로 폐의 질환을 구별하는 데 보다 적절하고 유용한 진단적 정보를 얻을 수 있을 것이다.   Purpose: The diagnostic utility of fluorine-18 2-deoxy-D-glucose positron emission tomograhpy (¹?F- FDG PET) for the non-invasive differentiation of focal lung lesions originated from cancer or inflammation disease by combined visual image interpretation and semi-quantitative uptake value analysis has been documented. In general, Standardized Uptake Value(SUV) is used to diagnose lung disease. But SUV does not contain dynamic information of lung tissue for the glucose. Therefore, this study was undertaken to hypothesis that analysis of dynamic kinetics of focal lung lesions base on ¹?F-FDG PET may more accurately determine the lung disease. So we compared Time Activity Curve(TAC), Standardized Uptake Value-Dynamic Curve(SUV-DC) graph pattern with Glucose Metabolic Rate(MRGlu) from Patlak analysis.<BR>  Methods: With lung disease, 17 patients were examined. They were injected with ¹?F-FDG over 30-s into peripheral vein while acquisition of the serial transaxial tomographic images were started. For acquisition protocol, we used twelve 10-s, four 30-s, sixteen 60-s, five 300-s and one 900-s frame for 60 mins. Its images were analyzed by visual interpretation TAC, SUV-DC and a kinetic analysis(Patlak analysis). The latter was based on region of interest(ROIs) which were drawn with the lung disease shape. Each optimized patterns were compared with itself.<BR>  Results: In TAC patterns, it hard to observe cancer type with inflammation disease in early pool blood area but over the time cancer type slope more remarkably increased than inflammation disease.<BR>  SUV-DC was similar to TAC pattern. In the result of Patlak analysis, In time activity curve of aorta, even though inflammation disease showed higher blood activity than cancer, at first as time went by, blood activity of inflammation disease became the lowest. However, in time activity curve of tissue, cancer had the highest uptake and inflammation disease was in the middle.<BR>  Conclusion: Through the examination, TAC and SUV-DC could approached the results that lung cancer type and inflammation disease type has it’s own difference shape patterns. Also, it has outstanding differentiation between cancer type and inflammation in Patlak and MRGlu analysis. Through these analysis methods, it will helpful to separation lung disease.

Interstitial Lung Disease and Lung Cancer Development: A 5-Year Nationwide Population-Based Study

최원일,박순효,박병주,이충원 대한암학회 2018 Cancer Research and Treatment Vol.50 No.2

Purpose In this nationwide 5-year longitudinal population-based study, we aimed at investigating the incidence of lung cancer among patients with interstitial lung disease. Materials and Methods Data was collected from the Korean National Health Insurance Research Database from 49,773,195 Korean residents in 2009. Thirteen thousand six hundred and sixty-six patients with interstitial lung disease diagnosed January-December 2009. The end of follow-up was June 30, 2014. Up to four matching chronic obstructive pulmonary disease controls were selected to compare the lung cancer high-risk group based on age, sex, diagnosis date (within 30 days), and hospital size. The number of patients with newly developed lung cancer was determined. Results The incidences of lung cancer were 126.98, 156.62, and 370.38 cases per 10,000 person- years (2,732, 809, and 967 cases of cancer, respectively) in the chronic obstructive pulmonary disease, interstitial lung disease, and chronic obstructive pulmonary disease with interstitial lung disease groups, respectively. Of the 879 patients with idiopathic pulmonary fibrosis, 112 developed lung cancer (incidence, 381.00 cases per 10,000 personyears). Conclusion Incidence of lung cancer among patients with interstitial lung disease was high. Interstitial lung diseases have a high potential for developing into lung cancer, even when concurrent with chronic obstructive pulmonary disease.

편측성 폐질환 환자의 체위변경이 생리적 지표에 미치는 영향

조지연,이향련 성인간호학회 2000 성인간호학회지 Vol.12 No.1

The purpose of this study was to identify the effect of body positioning on PaO₂, SpO₂, systolic blood pressure, diastolic blood pressure, pulse, and respiration(above all defined physiologic index), of patients with unilateral lung disease. The subjects for this study were eleven patients admitted to I.C.U. of K.H.M.C. with a diagnosis of unilateral lung disease confirmed by chest X-ray and the attending doctor, from January 30th, to April 20th, 1999. A quasi-experimental repeated-measures cross-over design was used to compare three body positions(semi-Fowler's, lateral decubitus with good lung dependent, and lateral decubitus with diseased lung dependent). Each subject spent 30 minutes in semi-Fowler's position and 2 hours in good lung dependent position and diseased lung dependent position. Starting in the semi-Fowler's position, then in the lateral position with the good lung dependent or the disease lung dependent as assigned in random order. Thirty minutes after each positioning, arterial blood sample was analyzed. Measurements of all physiologic index were recorded at the specified intervals(0, 30, 60, 90 and 120 minutes) in good lung dependent and diseased lung dependent position. Statistical comparison of PaO₂ value was done using the Wilcoxen Signed Rank Test, and Multivariate repeated-measures analysis of variance was performed to analyse the within-subject effect of two dependent position for 2 hours on the five dependent variables: ① PaO₂ ② SpO₂ ③ systolic blood pressure ④ diastolic blood pressure ⑤ pulse. The results obtained were as follows: 1. The PaO₂ value in the good lung dependent position was significantly higher than the PaO₂ value in the diseased lung dependent position(Z=-2.8451, p=.002), 2. The PaO₂ value in the good lung dependent position was significantly higher than the PaO₂ value in the semi-Fowler's position(Z=2.6673, p=.003). 3. The difference between the PsO₂ value in the semi-Fowler's position and the PaO₂ value in the diseased lung dependent position was not significant(Z=-102448, p=.10). 4. There were no statistically significance in the trends of physiologic index in the good lung dependent position and the diseased lung dependent position. From the results, it may be concluded that the good lung dependent position is the most effective position for patients with unilateral lung disease that improve oxygenation. Identification of positioning over time may be need further studies.

만성 간질성 폐질환의 병리

신동환 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.1

Short-Term Lung Function Changes and Predictors of Progressive Systemic Sclerosis-Related Interstitial Lung Disease

( Punchalee Kaenmuang ),( Asma Navasakulpong ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.4

Background: Systemic sclerosis (SSc) involves multiple organ systems and has the highest mortality among connective tissue diseases. Interstitial lung disease is the most common cause of death among SSc patients and requires closer studies and follow-ups. This study aimed to identify lung function changes and predictors of progressive disease in systemic sclerosis-related interstitial lung disease (SSc-ILD). Methods: A retrospective study extracted SSc patients from an electronic database January 2002-July 2019. Eligible cases were SSc patients >age 15 diagnosed with SSc-ILD. Factors associated with progressive disease were analyzed by univariate and multivariate logistic regression analyses. Results: Seventy-eight SSc-ILD cases were enrolled. Sixty-five patients (83.3%) were female, with mean age of 44.7±14.4, and 50 (64.1%) were diffuse type SSc-ILD. Most SSc-ILD patients had crackles (75.6%) and dyspnea on exertion (71.8%), and 19.2% of the SSc-ILD patients had no abnormal respiratory symptoms but had abnormal chest radiographic findings. The most common diagnosis of SSc-ILD patients was non-specific interstitial pneumonia (43.6%). The lung function values of diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO per unit alveolar volume declined in progressive SSc-ILD during a 12-month follow-up. Male and no previous aspirin treatment were the two significant predictive factors of progressive SSc-ILD with adjusted odds ratios of 5.72 and 4.99, respectively. Conclusion: This present study showed that short-term lung function had declined during the 12-month follow-up in progressive SSc-ILD. The predictive factors in progressive SSc-ILD were male sex and no previous aspirin treatment. Close follow-up of the pulmonary function tests is necessary for early detection of progressive disease.

CASE REPORT : A Case of IgG4-Related Lung Disease Presenting as Interstitial Lung Disease

( Jee Hwan Ahn ),( Sun In Hong ),( Dong Hui Cho ),( Eun Jin Chae ),( Joon Seon Song ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.2

Intrathoracic involvement of immunoglobulin G4 (IgG4)-related disease has recently been reported. However, a subset of the disease presenting as interstitial lung disease is rare. Here, we report a case of a 35-year-old man with IgG4-related lung disease with manifestations similar to those of interstitial lung disease. Chest computed tomography showed diffuse ground glass opacities and rapidly progressive pleural and subpleural fibrosis in both upper lobes. Histological findings showed diffuse interstitial lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. Serum levels of IgG and IgG4 were also increased. The patient was diagnosed with IgG4-related lung disease, treated with anti-inflammatory agents, and showed improvement. Lung involvement of IgG4-related disease can present as interstitial lung disease and, therefore, should be differentiated when evaluating interstitial lung disease.

각종 간질성폐질환에서 폐포 대식세포의 Superoxide 분비능과 식균 작용

송정섭(Jeong Sup Song),김영균(Young Kyoon Kim),김관형(Kwan Hyoung Kim),한기돈(Ki Don Han),문화식(Hwa Sik Moon),신완식(Wan Shik Shin),박성학(Sung Hak Park) 대한내과학회 1990 대한내과학회지 Vol.39 No.3

N/A Interstitial lung diseases are a heterogenous group of disorders characterized by various degrees of parenchymal alveolitis and fibrosis. Alveolar macrophages (AM) are the predominant inflammatory cell type within alveolar structures and function not only as phagocytic cells but also as secretory cells that release various secretory products involving oxygen metabolites. Alveolar macrophages from patients with interstitial lung disease are thought to participate in the injury to the alveolar wall and contribute to the development of interstitial fibrosis. To investigate the role of alveolar macrophages in interstitial lung diseases, we measured the amount of superoxide release and phagocytosis by AM after bronchoalveolar lavage (BAL) from the normal controls and cases with interstitial lung diseases. The results were summerized as follows: 1) The total number of inflammatory cells in the BAL fluids increased more in patients with interstitial lung diseases than in the controls (p<0.02). 2) The differential cell count of BAL inflammatory cells showed that lymphocytes were predominant in sarcoidosis, hypersensitivity pneumonitis, and collagen lung disease, while neutrophils were predominant in idiopathic pulmonary fibrosis and bleomycin-induced pneumonitis. 3) The superoxide release by AM in patients with interstitial lung diseases was higher than the normal controls, either spontaneously or after stimulation by phorbol myristate acetate (PMA)(p<0.05). 4) The phagocytosis of non-opsonized staphylococcus aureus by AM was elevated in the interstitial lung disease cases (p<0.02), but no difference was noted when using the opsonized staphylococcus aureus as a target. These results suggest that AM are activated in interstitial lung diseases, and increased production of oxidant by AM in interstitial lung diseases may play a critical role in tissue damage and pulmonary fibrosis. Elevation of oxygen metabolite release by AM could be a useful marker in the assessment of the activity of interstitial lung diseases.

Immunoglobulin G4-Related Lung Disease Mimicking Lung Cancer: Two Case Reports

Dae Yun Park,Su Young Kim,Suk Hyun Bae,Ji Young Lee 대한영상의학회 2022 대한영상의학회지 Vol.83 No.5

Immunoglobulin G4 (IgG4)-related disease is a rare systemic fibroinflammatory condition characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in various organs. IgG4-related lung disease shows varied radiologic features on chest CT. Patients usually present with a solid nodule or mass mimicking lung cancer; therefore, distinguishing between IgG4-related disease and other conditions is often challenging. Additionally, co-existing radiologic findings of IgG4- related lung disease may mimic metastasis or lymphangitic carcinomatosis of the lung. We report two cases of histopathologically confirmed IgG4-related lung disease mimicking lung cancer. Chest CT revealed a solid nodule or mass with ancillary radiologic findings, which suggested lung cancer; therefore, IgG4-related lung disease was radiologically indistinguishable from lung cancer in both cases. Measurement of serum IgG4 levels and clinical evaluation to confirm involvement of various organs may be useful to establish the differential diagnosis. However, surgical biopsy evaluation is needed for confirmation.

류마티스 관절염 환자에서 간질성 폐질환 유무에 대한 임상 양상의 비교

지종대 ( Jong Dae Ji ),이영호 ( Young Ho Lee ),송관규 ( Gwan Gyu Song ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Objective: To determine the clinical, laboratory and radiologic factors related to interstitial lung disease in patients with rheumatoid arthritis. Method: 10 patients with rheumatoid arhritis and interstitial lung disease, and 20 patients with rheumatoid arthritis as controlled group were included in this study. Interstitial lung disease was diagnosed by pulmonary function test and high resolution computed tomography. We evaluated the importance of rheumatoid arthritis-specific factors on the interstitial lung disease. Results: 1) patients with interstitial lung disease(mean, 64.40±8.38) were older than those without interstitial lung disease(52.5±14.0). 2) The sex ratio, duration of disease and smoking history were similar between two groups. 3) The incidence of subcutaneous nodule(15 vs 0%, p<0.05) and sputum (15 vs 0%, p<0.05) was different between two groups. The number of joints with swelling(8.62±8.37 vs 3.25±1.59, p<0.05) and tenderness(14.1±10.1 vs 7.10±4.04, p<0.05) was different. But the incidence of cough, fever, dyspnea and chest pain was not different between two groups. 4) C-reactive protein(51.5±35.9mg/l vs 18.9±17.9mg/l, p<0.05) was different between two groups. Hematocrit, platelet, erythrocyte sedimentation rate, hand radiographic evidence of bone erosion was not different. Titer of rheumatoid factors(235±192IU/ml vs 115±158IU/ml, p=0.09) was different between two groups, but was not statistically significant. Conclusion: We found that the incidence of subcutaneous nodule, sputum, number of tenderness and swelling of the joints, C-reactive protein in group with interstitial lung disease was higher than group without interstitial lung disease.

폐쇄용적(Closing volume)증가가 일측성 폐질환자의 체위에 따른 동맥혈 산소분압 변동에 미치는 영향

김용태,임채만,진재용,고윤석,김우성,김원동 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

일측성 폐질환자에서 건측 폐 하위시 환측 폐 하위시 보다 동맥혈 산소량이 높게 유지 된다는 것은 잘 알려져 있다. 이는 일반적으로 중력에 의해 하부폐에 환기, 관류가 더 많이 일어나기 때문이다. 한편 유아에서는 흉곽벽이 단단하지 못하고 폐에 대한 견인력이 약하여 흉막강 압력이 덜 음압인 것으로 알려져 있다. 따라서 유아에서는 하부폐의 기도폐쇄가 쉽게 일어나며 일측성 폐질환에서, 건측폐 하위시 보다 오히려 환측폐 하위시 동맥혈 산소분압이 더 높다고 알려져 있다. 이에 저자들은 일측성 폐질환을 가진 성인에서도 폐쇄용적이 증가된 경우 건측 폐를 상부로 하였을 때에 건측 폐를 하부로 하였을 때 보다 동맥혈 산소분압이 더 높을 수 있다고 가정하였다. 39명의 일측성 폐질환 환자를 대상으로 즉, 체위별, 정와위, 우와위에서 동맥혈 가스분석을 시 행하였으며 이중 18명의 환자에서 폐활량 측정법의 측정치 및 폐쇄용적을 측정비교하였다. 1. 건측 폐 하위시 동맥혈 산소분압이 높았던 군(A군)에서 건측 폐 하위 와위시 평균 Pao₂는 88.5±15.1mmHg, 환측 하위 와위시 평균 Pao₂는 78.6±13.3이었다.(P<0.001) 2. 한측 폐 하위시 동맥혈 산소분압이 높았던 군(B군)에서 건측 폐 하위 와위시 평균 Pao₂는 79.4±5.3, 환측 하위 와위시 평균 Pao₂는 87.9±6.2이었다.(P<0.001) 3. A군에서 평균 FVC는 78.2±14.8, FEV1은 61.5±21.3%, FEF25-75%는 57.9±23.4%이었고 B군에서는 평균 FVC는 63.7±28.6%, FEV1은 59.2±26.2%, FEF25-75%는 67.5±26.2% 이었다. 4. A군에서 CV은 87.8±13.6%, B군에서는 CV은 121±18.8%으로서 양군 사이에 유의한 차이가 있었다.(P<0.05). 이상의 결과로서 폐쇄용적이 증가한 환자에서 일측성 폐질환의 경우 동맥혈 산소분압이 환측 폐 하위시 건측 폐 하위시 보다 높을 수 있음을 관찰하였다. In unilateral lung disease, it is well known that good lung dependent position has higher Pao₂than bad lung dependent lateral decubitus position. Usually the lung base is more perfused and more ventilated than the apex because of gravity and lung weight. But infants have the floppier chest wall than adults and the resting pleural pressure in infants is more positive than that of adult. In infants, peripheral airways on dependent lung regions may be easily closed and therefore infants have large closing volume. In fact, it is well known that infants have higher Pao₂at bad lung dependent position than at good lung dependent position in unilateral lung disease. We assumed that in adult if closing volume is increased, bad lung dependent position could have higher Pao₂ than good lung dependent position. In 39 patients with unilateral parenchymal lung disease, we analysed changes of blood gas status in various body position(supine, right and left decubitus). Spirometry and closing volume were measured in 18 patients. The results are as follows. 1) In patients with higher Pao₂ at good lung dependent position, mean Pao₂was 88.5±15.1 mmHg at good lung dependent position and 78.6±13.3 mmHg at bad lung dependent position(P<0.001). 2) In patients with higher Pao₂at bad lung dependent position, mean Pao₂was 79.4±5.3 mmHg at good lung dependent position and 87.9±6.2 mmHg at bad lung dependent position(P<0.01). 3) Closing volumes were significantly different between patients with higher Pao₂at good lung dependent position and patients with higher Pao₂ at bad lung dependent position(87.8%±13.6% vs, 121±18.8%, p<0.05). From these results, we observed that patients with increased closing volume could have higher Pao₂at bad lung dependent position than at good lung dependent position.