유방질환에 대한 방사선 진단의 최신경향

文宇京 대한의사협회 1998 대한의사협회지 Vol.41 No.2

분자 자기공명영상

문우경 대한의사협회 2004 대한의사협회지 Vol.47 No.2

소아 폐결핵:전산화단층촬영 소견

문우경 대한영상의학회 1996 대한영상의학회지 Vol.34 No.6

소아폐결핵의 다양한 CT소견을 기술하고 CT검사의 유용성을 단순촬영과 비교하고 자 한다. 소아 폐결핵의 흔한 CT소견은 종격동 또는 폐문부 임파절 비대, 폐실질 병변, 미 만성 결절등이며, 병변내의 건락성괴사를 나타내는 저음영, 석회화, 기관지를 따라 전파된 결절등은 특징적이다. CT검사는 단순촬영에서 불명확한 병변의 발견, 특징적 소견에 의거한 진다, 병변의 범의 및 합병증등의 평가에 유용하다. This paper illustrates the spectrum of CT findigns of pulmonary tuberculosis in children and shows theadvantages and complementary nature of CT compared with conventional radiography. Common CT manifestations ofpulmonary tuberculosis in children are mediastinal or hilar lymphadenopathy, air-space consolidation, atelectasisand disseminated nodules. CT is useful in the detection of the disease in equivocal chest radiographs, in thecharacterization of lesions, by demonstrating caseation necrotic areas, calcification and bronchogenic spreadnodules, and in defining the extent of the disease and its complications. This in formation will be helpful in thediagnosis and evaluation of tuberculosis in children.

MR조영제와 분자영상

문우경 대한핵의학회 2004 핵의학 분자영상 Vol.38 No.2

The two major classes of magnetic resonance (MR) contrast agents are paramagnetic contrast agents, usually based on chelates of gadolinium generating T1 positive signal enhancement, and super-paramagnetic contrast agents that use mono- or polycrystalline iron oxide to generate strong T2 negative contrast in MR images. These paramagnetic or super-paramagnetic complexes are used to develop new contrast agents that can target the specific molecular marker of the cells or can be activated to report on the physiological status or metabolic activity of biological systems. In molecular imaging science, MR imaging has emerged as a leading technique because it provides high-resolution three-dimension maps of the living subject. The future of molecular MR imaging is promising as advancements in hardware, contrast agents, and image acquisition methods coalesce to bring high resolution in vivo imaging to the biochemical sciences and to patient care. (Korean J Nucl Med 38(2):205-208, 2004)

유방촬영술의 임상영상평가: 전국조사

문우경,차주희,한부경,최연현,김은경,최혜영,정수영,연경모,Mun, U-Gyeong,Cha, Ju-Hui,Han, Bu-Gyeong,Choe, Yeon-Hyeon,Kim, Eun-Gyeong,Choe, Hye-Yeong,Jeong, Su-Yeong,Yeon, Gyeong-Mo 대한영상의학회 2003 대한영상의학회지 Vol.49 No.6

목적:우리나라 유방촬영술 임상화질의 실태를 파악하고자 하였다. 대상과 방법:전국 257개 병의원에서 수집된 598예의 유방촬영사진에 대해 자세잡기,압박,대조도,노출수준,선명도,잡음,인공물,표지 등 8개 항목을 점수법 (1점,심각한 결함;2점,중요한 결함;3점,사소한 결함;4점,양호;5점,최상)으로 분석하였다.불합격은 임상영상평가 8항목중 4항목이상에서 3점이하인 경우나 인공물이나 표지를 제외한 항목에서 1-2점이 있는 경우로 했다.그 성적을 병원 종류 및 평가 항목별로 분석하였다. 결과:유방촬영 사진 598예 중 36.3%(217예)가 불합격으로 판정되었으며 병원종류별 불합격률은 대학병원 8.9%(11/123)(p<.01,Chi-square test),방사선과의원 38.2%(39/102),종합병원 42.6%(92/216),비방사선과의원 47.7%(42/88),법인의료단체(건강관리협회와 보건소)47.8%(33/69)였다.항목별 불합격률은 총 598예중 자세잡기 23.7%(142예)(p<.01,Chi-square test),표지 5.7%(34예),노출 5.4%(32예),대조도 4.2%(25예),선명도 2.7%(16예),압박 2.5%(15예),인공물 2.5%(15예),잡음 0.3%(2예)순이었다. 결론:전체 유방촬영 사진의 36.3%가 진단적 가치가 없는 것으로 나타났으며 대학병원보다는비방사선과의원이나 법인의료단체의 불합격률이 유의하게 높았다. Purpose: The goal of this study was to survey the overall quality of mammographic images in Korea. Materials and Methods: A total of 598 mammographic images collected from 257 hospitals nationwide were reviewed in terms of eight image quality categories, namely positioning, compression, contrast, exposure, sharpness, noise, artifacts, and examination identification, and rated on a five-point scale: (1=severe deficiency, 2=major deficiency, 3=minor deficiency, 4=good, 5=best). Failure was defined as the occurrence of more than four major deficiencies or one severe deficiency (score of 1 or 2). The results were compared among hospitals of varying kinds, and common problems in clinical image quality were identified. Results: Two hundred and seventeen mammographic images (36.3%) failed the evaluation. Poor images were found in descending order of frequency, at The Society for Medical Examination (33/69, 47.8%), non-radiology clinics (42/88, 47.7%), general hospitals (92/216, 42.6%), radiology clinics (39/102, 38.2%), and university hospitals (11/123, 8.9%) (p<0.01, Chi-square test). Among the 598 images, serious problems which occurred were related to positioning in 23.7% of instances (n=142) (p<0.01, Chi-square test), examination identification in 5.7% (n=34), exposure in 5.4% (n=32), contrast in 4.2% (n=25), sharpness in 2.7% (n=16), compression in 2.5% (n=15), artifacts in 2.5% (n=15), and noise in 0.3% (n=2). Conclusion: This study showed that in Korea, 36.3% of the mammograms examined in this sampling had important image-related defects that might have led to serious errors in patient management. The failure rate was significantly higher in non-radiology clinics and at The Society for Medical Examination than at university hospitals

호르몬대체요법과 관련된 유방의 이상소견: 외과적 생검 증례 분석

문우경,차주희,Mun, U-Gyeong,Cha, Ju-Hui 대한영상의학회 2004 대한영상의학회지 Vol.50 No.1

목적:호르몬대체요법 중 발견된 유방촬영술 및 초음파검사상의 이상소견과 병리학적 결과를 비교 분석하고 호르몬대체요법 도중 발견되는 유방암의 특징적인 임상, 유방촬영술, 병리 소견이 있는지 알아보고자 한다. 대상과 방법:호르몬대체요법 치료도중 유방촬영술의 이상소견 또는 촉지성 종괴로 유방암이 의심되어 외과적 유방절제술을 시행한 총 25명(44-65세;평균 55.5세)을 대상으로 하였다. 유방촬영술은 모든 환자에서,초음파 검사는 23명에서 시행하였으며,종괴의 모양과 변연, 미세석회화 등 영상 소견을 병리결과와 비교 분석하였다.호르몬대체요법를 받은 과거력이 없는 45명(44-65세;평균 54.9세)의 유방암 환자를 대조군으로 하여 유방암 발견방법, 유방촬영술 소견, 관상피내암 비율 등을 비교하였다. 결과:수술결과 양성질환 10예(섬유선종 4예,섬유낭성변화 6예)와 악성종양 15예(관상피내암3예,침윤성암 12예)로 판명되었다. 25명 환자의 유방촬영술상 이상소견은 종괴 16예, 군집성미세석회화 7예,종괴와 미세석회화 2예이었다. 유방촬영술 소견과 병리결과를 비교하면, 국한형 종괴는 4예 모두에서 양성인 반면, 불명확형 종괴는 7예 중 5예 (71%),침상형 종괴는 5예 모두 (100%)에서 악성이었다. 미세석회화를 보인 7예 중 3예 (43%)와 종괴와 미세석회화가 함께 보인 2예 모두에서 악성종양이 발견되었다.초음파검사상 낭종만 관찰되었던 2예는 모두 양성으로 판정되었다. 호르몬대체요법과 연관하여 발견된 유방암은 호르몬대체요법를 받은 과거력이 없는 환자에서 발견된 유방암과 비교해서 유의하게 유방촬영술로 발견된 경우가 많았으며 (60%와 16%,p<0.001),종양의 평균 크기가 작았고 (17 mm와 24 mm,p <0.01),미세석회화로만 나타난 증례가 많았으며(20%와 13%,p <0.05),조직학적으로 관상피내암이 많았다 (20%와 7%,p <0.01). 결론:호르몬대체요법도중 발견된 유방촬영상의 이상소견 중 불명확형 또는 침상형 종괴와 미세석회화와 동반된 종괴는 유방암의 가능성이 높았다.호르몬대체요법도중 진단된 유방암은 호르몬대체요법과 무관한 유방암에 비해 유방촬영술에서 유의하게 많이 발견되었으며 조직학적으로 관상피내암이 많았다. Purpose: To correlate the mammographic and ultrasonographic findings with the pathologic results in women undergoing hormone replacement therapy (HRT), and to determine the characteristic clinical, mammographic or histologic findings of breast cancer in these patients. Materials and Methods: Twenty-five breast lesions in 25 patients aged 44-65 (mean, 55.5) years undergoing HRT were surgically removed due to abnormal mammographic findings or the presence of palpable masses. Mammograms in all patients and ultrasonograms in 23 were retrospectively analyzed in terms of the shape and margin of the mass, and microcalcifications, and the imaging findings were correlated with the pathologic results. As a control group, 45 cancer patients not undergoing HRT were selected. Using the student t test, detection methods, tumor size, mammographic findings, and the proportion of intraductal cancers were compared between the two groups. Results: Surgical excision revealed ten benign lesions (four fibroadenomas and six cases of fibrocystic change) and 15 cancers (three intraductal and twelve invasive ductal cancers). Abnormal findings at mammography were a mass in 16 cases, clustered microcalcifications in seven, and a mass with microcalcifications in two. Mammography showed that all four circumscribed masses were benign. Five of seven ill-defined masses (71%) and all six spiculated masses were malignant. Three of seven cases (43%) with microcalcification, and both with a mass and microcalcification, were malignant. In two cases in which ultrasonography revealed cystic lesions, histologic examination showed that fibrocystic change had occurred. Compared to non-HRT-related cancers, HRT-related cancers were more often detected by mammography (60% vs 16%; p <0.001), smaller (17 mm vs 24 mm, p <0.01), showed microcalcification only (20% vs 13%; p <0.05), and were intraductal (20% vs 7%; p <0.01). Conclusion: In patients with HRT, mammographic findings of an ill-defined or spiculated mass, or one with microcalcifications, were associated with breast cancer. Compared to non-HRT-related cancers, breast cancers in patients undergoing HRT tend to manifest more frequently as a mammographic abnormality, and to be intraductal.

종격동 결핵성 림프절염의 전산화단층촬영 유형과 치료반응의 분석

문우경 대한영상의학회 1993 대한영상의학회지 Vol.29 No.5

To see the usefulness of CT in evaluation of response to treatment in patients with mediastinal tuberculous lymphadenitis (MTL), we analyzed the initial CT patterns and follow-up CTs or serial plain radiographs during 18 months antituberculous chemotheraphy in 58 consecutive patients. CT patterns of MTL at the beginning of treatment were categorized into solid type (n=8), low density with peripheral rim enhancement type (n=36), extranodal extension type (n=9) and calcified type (n=5). According to the response to treatment, each patient was categorized into prompt response group (response after three months but residual lesion after one year), no response group (no change in size during 18 months treatment) and temporal increase group (temporal increase in size during the treatment but ultimately improved with chemotheraphy) Among 29 cases of prompt response group, 20 cases had large low-density areas. 6 cases had diffuse or extensive node involvement with extranodal extension or tracheal compression. Two patients with acquired immune deifciency syndrome belonged to this group. Fifteen cases of slow response group had low-density nedes in 7 patients and small solid or extranodal-extension or tracheal compression. Two patients with acquired immune deifciency syndrome belonged to this group. Fifteen cases of slow response group had low-density nedes in 7 patients and small solid or extranodal-extension nodes in 6 patents. They were associated with disseminated pulmonary tuberculosis, generalized lymphadenopathy or other organ (pericardium, brain, bone, or abdomen) involvement. In 5 cases of no response group, there were 3 cases of calcified node and 2 cases of small soild nodes. Nine cases of temporal increase group included low density type of MTL only. And they were associated with disseminated pulmonary of endobronchial tuberculosis. In conclusion, response to antituberculous chemotherapy could be predicted in patients with MTL on the basis of CT findings before treatment

소아에서의 간 미분화배아육종

문우경 대한영상의학회 1992 대한영상의학회지 Vol.28 No.5

Undifferentiated embryonal sarcoma (UES) is an uncommon malignant hepatic tumor that occurs in older children and young adults. Six cases of UES were reviewed to determine their characterisfic findings on sonography (US) (n=5), computed tomography (CT) (n=6), and angiography (n=2) US demonstrated a single large, echogenic mass with some anechoic spaces in each case. CT revealed a well demarcated hypodense mass with hyperdinse septa of variable shape and thickness. Four cases showed enhancing peripheral rim and some solid portions at the periphery or adjacent to the septa. Follow-up CT scan in one case who had not been treated showed enhancing solid portion changed to hypodense areas. Angiography showed hypovasculsr of avaxcular mass. Familiarity with these radiological findings of UES of liver will be helpful in differential diagnosis of primary hepatic tumors of childhood.

유방 탄성초음파의 검사방법과 판독상의 주의점

문우경,장정민,조나리야 대한초음파의학회 2011 ULTRASONOGRAPHY Vol.30 No.4

Ultrasound (US) elastography is a tool that indicates the hardness of a lesion. Recent studies using elastography with freehand compression have shown similar diagnostic performance to conventional US in differentiating benign lesions from malignant breast masses. On the other hand, the acquired information is not quantitative,and the reliability of the imaging technique to correctly compress the tissue depends on the skill of the operator, resulting in substantial interobserver variability during data acquisition and interpretation. To overcome this, shear wave elastography was developed to provide quantitative information on the tissue elasticity. The system works by remotely inducing mechanical vibrations through the acoustic radiation force created by a focused US beam. This review discusses the principles and examination techniques of the two types of elastography systems and provides practical points to reduce the interobserver variability or errors during data acquisition and interpretation. 유방 탄성초음파는 조직의 경도를 영상화하는 검사법으로 가압에 의한 변형을 영상화하는 변형탄성방식과 집속음향을 가한후 발생하는 횡파의 속도를 계측하는 횡탄성방식으로 구분된다. 탄성초음파를 B-모드 초음파와 함께사용하면 유방종괴의 양성-악성 감별과 초음파의 특이도향상에 기여할 수 있다. 하지만 탄성초음파는 검사자의 숙련도에 따라 정확도가 달라질 수 있으므로 적정한 검사방법 및 판독법상의 주의점을 숙지하고 있어야 오진을 막을수 있다.

결절성 경화증의 자기공명 영상소견

문우경 대한영상의학회 1992 대한영상의학회지 Vol.28 No.6

Magnetic resonance (MR) imaging of thirteen patients with tuberous sclerosis were reviewed. Seven patients underwent computed tomography (CT). The characteristic MR finding of tuberous sclerosis was those of subependymal nodules which were best seen on short repetition time (TR) spin-echo images. Hypointensities within the nodules consistent with calcification were most evident on long TR images. Contrast enhancing lesions, indicative subependymal giant cell astrocytoma, occurred in four cases. Cortical tubers (n=11) and wite matter lesions (n=8) exhibited long T1 and T2 relaxation characteristics although reversed pattern was noted in one newborn patients. Cortical tubers and white matter lesions had more irregular shapes in early childhood patients. MR imaging is the sensitive method in detection of gyral tubers and white matter lesions and also valuable in detecting giant cell astrocytoma.