다중검출기 CT를 이용한 돼지 척추뼈의 미세골구조분석: 삼차원 CT 조직형태계측법의 재현성 평가

안상부,홍성환,구진모,문경철,김광기 대한영상의학회 2011 대한영상의학회지 Vol.64 No.5

목적: 다중검출기 CT를 이용한 3차원 조직형태계측법을 통해 미세골구조 분석의 재현성을 평가하고자 하였다. 대상과 방법: 해면골구조가 비교적 잘 보이는 돼지 척추골 36개를 선별하여 CT 스캔을 시행하였다. 64채널 다중검출기 CT를 이용하여 각 검체에 대해 다섯 번씩 반복 스캔하였고 이때 검체의 위치와 스캔 파라미터(parameters)는 동일하게 유지하였다. 각각의 영상 데이터를 소프트웨어를 이용하여 분석함으로써 3차원 미세골구조를 측정하고 측정치를 비교하여 미세골구조 분석의 재현성을 평가하였다. 측정한 3차원 미세골구조 지표들은 trabecular bone volume, trabecular bone volume/tissue volume, trabecular thickness, trabecular separation, trabecular number, trabecular bone pattern factor, structural model index였다. 결과: 미세골구조 지표들은 반복스캔에서 등급 내 상관계수가 0.998 - 1.000으로 측정되었고 structural model index를 제외한 6개 지표에서는 각각의 변동계수의 평균이 1.6%를 넘지않아 우수한 재현성을 보였다. 결론: 다중검출기 CT를 이용한 3차원 조직형태계측법은 미세골구조 분석에서 매우 재현성이 높은 검사임을 확인하였다. 이 방법은 임상 영역에서도 비침습적으로 쉽게 적용할 수 있을 것으로 생각한다. Purpose: To evaluate the reproducibility of 3-dimensional histomorphometry for the microarchitecture analysis of trabecular bone parameters using multidetector computed tomography (MDCT). Materials and Methods: Thirty-six specimens from porcine vertebral bodies were imaged five times with a 64-detector row MDCT system using the same scan protocols. Locations of the specimens were nearly identical through the scans. Three-dimensional structural parameters of trabecular bone were derived from the five data sets using image analyzing software. The features measured by the analysis programs were trabecular bone volume, trabecular bone volume/tissue volume, trabecular thickness, trabecular separation, trabecular number, trabecular bone pattern factor, structural model index. Results: The structural trabecular parameters showed excellent reproducibility through repeated scanning. Intraclass correlation coefficients of all seven structural parameters were in the range of 0.998 to 1.000. Coefficients of variation of the six structural parameters, excluding structural model index, were not over 1.6%. Conclusion: The measurement of the trabecular structural parameters using multidetector CT and three-dimensional histomophometry analysis program was validated and showed excellent reproducibility. This method could be used as a noninvasive and easily available test in a clinical setting.

Giant Cell Tumor of Soft Tissue: a Case with Atypical US and MRI Findings

안상부,최정아,정진행,오주한,강흥식 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.5

We report the case of a giant cell tumor with diffuse interstitial hemorrhaging and unusually prominent cystic components in the soft tissue of the thigh which has not been reported previously. Magnetic resonance image (MRI), showed signal intensity typical of a giant cell tumor. However, because of its conspicuous large well-circumscribed cystic components, the differential diagnoses, based on the image findings from an ultrasonography (US) and MRI, were complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst.

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

안세진,김효철,정진욱,안상부,인용후,제환준,박재형 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.3

Objective: To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. Materials and Methods: We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. Results: A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Conclusion: Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

Right Gastric Venous Drainage: Angiographic Analysis in 100 Patients

성낙종,정진욱,김효철,박재형,제환준,안상부,조백환 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.1

Objective: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. Materials and Methods: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. Results: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher’s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). Conclusion: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage. Objective: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. Materials and Methods: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. Results: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher’s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). Conclusion: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.

문맥종양혈전을 동반한 간세포암의 국소 치료

황상연 ( Sang Youn Hwang ),김령고 ( Ryoung-go Kim ),최철원 ( Cheol-won Choi ),안상부 ( Sang Bu Ahn ) 대한간암학회 2016 대한간암학회지 Vol.16 No.2

Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have a extremely poor prognosis. According to the Barcelona Clinic Liver Cancer guideline, sorafenib is a standard therapy in this situation, but many clinicians still select locoregional therapy (LRT) such as transarterial therapy, external beam radiation therapy (EBRT), even surgical resection (SR) or combination of LRTs because the survival improvement by sorafenib is unsatisfactory. Based on recent meta-analysis and prospective study, transarterial chemoembolization (TACE) and transarterial radioembolization seem to be effective and safe therapeutic option that have comparable outcome to sorafenib. Recently large nationwide studies demonstrated that SR can be a potentially curative treatment in selected patients. Hepatic arterial infusion chemotherapy (HAIC) can be also good option, especially in Child class B patients based on small volume prospective studies. Moreover, multidisciplinary strategies based on the combination of LRTs (SR plus TACE, TACE + EBRT, TACE + Sorafenib, HAIC + EBRT etc.) may improve survival of HCC patients with PVTT. Finally we discuss individualized and tailored treatment strategies for different clinical situations. (J Liver Cancer 2016;16:69-81)

주문맥침범과 임파절 전이를 동반한 Child 등급 B인 간세포암 환자에서 방사선치료와 sorafenib 병합으로 종양의 부분관해를 경험한

황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),강현철 ( Hyun Cheol Kang ),최철원 ( Cheol Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2

Reserved liver function is one of the most important determinants of survivial in advanced hepatocellular carcinoma (HCC). Especially in cirrhotic patient with decompensated liver function, sorafenib for HCC with main portal vein invasion have limited efficacy and survival benefit. Therefore many clinicians or centers still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. However this multidisciplinary approach may increase treatment related toxicity such as liver failure, etc. Recently, studies for combination of RT and sorafenib for HCC with portal vein invasion have been tried and reported not only bettertherapeutic efficacy, but also more hepatic toxicity.Based on above suggestions, we herein offer our experience of a patient that although achieved survival gain via partial remission of intrahepatic tumor and main portal vein thrombosis and metastatic lymph node by combination therapy of RT and sorafenib, finally expired due to hepatictoxicity. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage decompenstated cirrhotic patients with HCC with main portal vein invasion. (J Liver Cancer 2014;14:120-126)

부신, 폐전이를 동반한 거대 간세포암 환자에서 경동맥 화학색전술, 방사선 치료, sorafenib을 병합하여 간내암과 부신전이의 완전관해를 경험한 1예

황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn,),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang-mo Yang ) 대한간암학회 2013 대한간암학회지 Vol.13 No.1

Extrahepatic metastasis (EHM) associated with hepatocellular carcinoma (HCC) has been increasing due to prolonged survival with recent advances in therapeutic approaches including locoregional therapy such as transarterial chemoemoblization (TACE), radiofrequency ablation and radiation therapy (RT). Though many guidelines recommended systemic therapy such as sorafenib in this situation, some clinicians or centers still select locoregional therapy because the survival improvement of 2 or 3 months by sorafenib is far from optimal. Moreover, some studies showed that complete and partial response of intrahepatic tumors can result in significant improvement of patient survival even in situation of EHM. Based on above suggestions, we herein offer our experience of a patient with complete remission of intrahepatic tumor and adrenal gland metastasis treated with combination therapy of TACE and RT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with EHM.

다발성 전이를 동반한 고령의 간세포암 환자에서 경동맥방사선색전술과 반복적 경동맥화학색전술로 간내암과 다발성 전이의 부분관해를 이룬 증례

황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jung Woo Im ),전기정 ( Ki Jeong Jeon ),안상부 ( Sang Bu Ahn ),박진영 ( Jin-young Park ) 대한간암학회 2018 대한간암학회지 Vol.18 No.2

The number of older adults with hepatocelluar carcinoma (HCC) has been increasing with longer life expectancy and earlier diagnosis and treatment. However, older patients have lesser function reserve of multiple organ systems, more disability rate. Therefore, the treatment of elderly HCC patients remains a challenge worldwide. Recently, studies suggests that the survival outcome of older patients may be comparable to that of younger patients and active treatment may achieve promising rates of local and systemic control in selected patients. Based on above suggestions, we herein offer our experience of a case achieved partial remission by sequential therapy of transarterial chemoembolization after transarterial radioemoblization in elderly HCC patient with multiple metastasis. Further study, maybe regarding a combination of locoregional and systemic treatment, is necessary on how to manage HCC in elderly patients. (J Liver Cancer 2018;18:151-156)

주문맥혈전증을 동반한 거대 간세포암 환자에서 정위 체부 방사선치료와 sorafenib 병합으로 종양의 완전관해 유도 후 위궤양천공이 발생한 1예

황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1

Hepatocellular carcinoma (HCC) patients with main portal vein invasion have a poor prognosis associated with a median survival time of 2.7 months. Though many guidelines recommended sorafenib in HCC patients with macrovascular invasion (MVI), many clinicians or centers still select locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib because the survival improvement by sorafenib only is expected to be shorter than that without MVI. However this multidisciplinary approach may increase treatment related toxicity such as liver failure etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (3-5 fractions) of large fraction size and is expected to new effective modality for HCC with MVI. Based on above suggestions, we herein offer our experience of a patient with perforation of radiation induced gastric ulcer after complete remission of tumor and main portal vein thrombosis by combination therapy of SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with main portal vein invasion.

담관 침범을 동반한 저혈관성 간세포암종에서 경동맥화학색전술, 정위 체부 방사선 치료, sorafenib을 병합하여 부분관해를 경험한 1예

황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2

Hepatocellular carcinoma (HCC) patients with bile duct invasion have a poor prognosis because many do not receive effective treatment. Surgical resection is thought to be only option of curative treatment, increasing chance of survival, but it is possible to minor group of patients because of poor reserved liver function associated with underlying liver disease and obstructive jaundice. Therefore many clinicians or centers still select locoregional therapy such as transarterial chemoembolization (TACE), radiation therapy (RT) etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (1-5 fractions) of large fraction size and is expected to salvage modality for HCC showed incomplete response of TACE due to vascularity or accessibility of feeding artery. Based on above suggestions, we herein offer our experience of a patient with partial remission of tumor by combination therapy of TACE, SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with bile duct invasion or sparse vascularity.