마음공부와 운명(運命)론에 대한 고찰: 수회논(輸廻論)을 중심으로

김성장 ( Seong Jang Kim ) 원광대학교 인체과학연구소 2007 원광인체과학회지 Vol.8 No.1

유방암이 의심되는 환자에서 Tc-99m MIBI 유방스캔의 진단적 역할 : 단일기관의 결과

김성장(Seong Jang Kim),김인주(ln Ju Kim),김용기(Yong Ki Kim),배영태(Young Tae Bae) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.3

N/A Purpose: Tc-99m MIBI scintimammography has been validated as an useful non-invasive diagnostic tool for the primary breast cancer. But most studies have included small population of patients. We have experienced a large study population and investigated the diagnostie usefulness of Tc-99m MIBI scintimammography in detection of primary breast cancer and axillary Iymph node metastasis. Materials and Methods: This study included 30S patients who underwent scintimammography for palpable breast masses or abnormal radiologic findings. Tc-99m MIRI scintirnammography was performed 10 minutes after intravenous injection of 925 MBq of Tc-99m MIBI. If the early image revealed abnormal finding, 3 hour delayed image was also acquired. We calculated early and delayed lesion to non-lesion ratios (L/N). The pathologic diagnosis was obtained from surgical operation or F.4AB and compared with the results of Tc-99m MIBI scintimammography. Results: Malignant breast diseases were 155 and benign ones were 150. Tc-99m MIBI scintimammography revealed 132 true positive, 23 false negative, 10 false positive, and 140 true negative cases. The sensitivity, specificity, positive predictive value and negative predictive value for the primary breast cancer detection were 85.2%, 93.4%, 92.9%, and 85.9%, respectively. The sensitivity, specificity, positive predictive and negative predictive values of Tc-99m MIBI scintimammography in detecting metastatic axillary lymph node involvement were 22%, 90.4%, 61.9% and 62.3%, respectively. Early L/N of malignant breast disease was significantly higher than that of benign one (2,44±0.97 vs 1.94±0.78, p=0.01). Delayed L/N had no significant difference between malignant an<l benign breast diseases (1.94±0.32 vs 1.91±0.73, p=0.43). Conclusion: Our study revealed that Tc-99m MIBI scintimammography was an useful diagnostic tool for the diagnosis of breast cancer. And early L/N ratio might provide complementary role in the detection of' breast cancer. Bu1 the Tc-99m MIBI scintimammography had limited value in the detection of small breast cancer (less than 1 cm) and axillary lymph node metastasis. (Korean J Nucl Med 2000;34:234-42)

비소세포폐암 환자의 양전자방출 단층촬영에서 골수 대사활성도의 항암화학요법에 대한 반응 예측

설희윤 ( Hee Yun Seol ),목정하 ( Jeong Ha Mok ),윤성훈 ( Seong Hoon Yoon ),김지은 ( Ji Eun Kim ),김기욱 ( Ki Uk Kim ),박혜경 ( Hye Kyung Park ),김성장 ( Seong Jang Kim ),김윤성 ( Yun Seong Kim ),이민기 ( Min Ki Lee ),박순규 ( Soon 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.1

연구배경: 양전자방출 단층촬영은 최근 폐암의 진단과 병기 결정에 널리 사용된다. 본 연구에서는 비소세포폐암 환자에서 양전자방출 단층촬영에서의 골수 대사활성도의 증가가 항암화학요법에 대한 반응과 관련성이 있는지 알아보고자 하였다. 방법: 조직학적으로 비소세포폐암으로 진단 받은 환자 중에 양전자 방출 단층촬영을 시행한 후 일차 항암화학요법을 시행 받은 환자를 대상으로 하였다. 대상군의 양전자 방출 단층촬영상 골수 대사활성도는 요추 1, 2, 3번의 FDG 섭취를 측정하여 평가하였고, 항암화학요법에 대한 반응은 Response Evaluation Criteria in Solid Tumors(RECIST)를 이용하여 평가하였다. 결과: 총 59명의 환자가 포함되었다. 대상군을 양전자 방출 단층촬영상 골수의 SUV가 1.37 이상인 군(21명, 35.6%)과 미만인 군(38명, 64.4%)으로 나누었고, 골수의 SUV와 간의 SUV의 비가 0.73 이상인 군(22명, 37.3%)과 미만인 군(37명, 62.7%)로 나누어 일차 항암화학요법에 대한 반응을 비교하였다. 골수의 SUV와 골수의 SUV와 간의 SUV의 비는 일차 항암화학요법에 대한 반응과 통계학적으로 유의한 차이가 없었다(p=0.142, 0.978). 결론: 비소세포폐암 환자에서 양전자방출 단층촬영에서 나타난 골수 대사활성도는 항암화학요법에 대한 반응과 관련성이 없었다. Background: 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used for the diagnosis and staging of non-small cell lung cancer (NSCLC). The aim of this study is to determine whether the bone marrow hypermetabolism seen on FDG-PET predicts a response to chemotherapy in patients with NSCLC. Methods: We evaluated the patients with advanced NSCLC and who were treated with combination chemotherapy. For determination of the standardized uptake value (SUV) of the bone marrow (BM SUV) on FDG-PET, regions of interest (ROIs) were manually drawn over the lumbar vertebrae (L1, 2, 3). ROIs were also drawn on a homogenous transaxial slice of the liver to obtain the bone marrow/liver SUV ratio (BM/L SUV ratio). The response to chemotherapy was evaluated according to the Response Evaluation Criteria in Solid Tumor (RECIST) criteria after three cycles of chemotherapy. Results: Fifty-nine NSCLC patients were included in the study. Multivariate analysis was performed using a logistic regression model. The BM SUV and the BM/L SUV ratio on FDG-PET were not associated with a response to chemotherapy in NSCLC patients (p=0.142 and 0.978, respectively). Conclusion: The bone marrow hypermetabolism seen on FDG-PET can not predict a response to chemotherapy in NSCLC patients.

정상 성인 무증상 흡연자 , 당뇨병 환자에서 99mTc-DTPA 폐제거율의 측정

김인주,김성장,김용기,김윤성,이민기,박순규 ( In Ju Kim,Seong Jang Kim,Yong Ki Kim,Yun Seong Kim,Min Ki Lee,Soon Kew Park ) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.3

Purpose: We measured pulmonary epithelial permeability by Tc-DTPA radioaerosol clearance in patients with diabetes and correlated with the presence of microangiopathy to understand the pathophysiology of pulmonary microangiopathy and evaluate Tc-DTPA radioaerosol clearance as a diagnostic test to assess pulmonary microangiopathy. Materials and Methods: We performed ' Tc-DTPA radioaerosol scan in 10 normal subjects, 10 asym-ptomatic smokers, 20 diabetic patients without history of smoking (10 with microangiopathy, 10 without microangiopathy). Tc-DTPA clearance half-time (T1/2) was calculated, then compared with the result of chest radiography and pulmonary function test. Results: Chest radiography and pulmonary function test were normal in all subjects. There were no significant difference of clinical or laboratory characteristics between these groups except age. The diabetic patients with micraangiopathy were significantly older (p<0.05). The T1/2of normal subjects and asyrnptomatic smokers were significantly different (65.2+23.7min vs 39.6+9.8min, p<0.05). For diabetic patients with microangiopathy, the T, was 90 5+46.5min and significantly delayed when compared with those of normals and asymptomatic smokers (p<0.05). However, the T1/2of diabetic patients without microangiopathy, 70.0+12.7 min, was not significantly different from those of normals or asyrnptomatic smokers (p>0.05). No significant correlation was found between the T1/2and spirometric parameters including DLcc>, FVC, FEV>, FEV(/FVC (%) and FEF)5-75g in all subjects, and between the T1/2 and duration of diabetes in diabetic patients. Conclusion: Eventhough the influence of age cant be excluded, delayed Tc-DTPA clearance half-time (T1/2)in diabetic patients with microangiopathy indicates decreased pulmonary cspillary permeability as one of the pathophysiologic results of pulmonary microangiopaththy. Further studies are needed in larger number of age matched control and diabetic patients to evaluate the diagnostic efficacy. (Korean J Nucl Med 1998;32:266-75)

청소년기형 척추측만증 환자의 체질량지수 및 골밀도

서근택(Kuen Taik Sub),김성장(Seong Jang Kim),이정섭(Jung Sub Lee) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.1

목적: 청소년기형 특발생 척추측만증 환자를 대상으로 체중과 신장에 따른 체질량 지수 및 골멸도를 측정하여 나이와 성이 같은 정상인과 비교하여 청소년기형 특발성 척추측만증 환자의 인체측정학적 요소의 특정을 알아보 파하였다. 대상 및 방법; 2003년 3월부터 2006년 3월까지 본원에 내원한 환자 중 새롭게 진단된 11-14세 여자 청소년기형 특발성 척추측만증 72예와 대조군 %예를 대상으로 체중, 신장, 체질량 지수를 측정하였으며 이중 에너지 방사 선 흡수 계측을 이용하여 요추부, 비우성 대퇴 경부, 대전자부, Ward 삼각부의 골밀도을 측정하여 비교 분석하였다. 결과: 청소년기형 특발성 척추측만증 72예의 평균 연령은 12.9세였으며 대조군 54예의 평균 연령은 13.1세였다. 두 군 사이에 통계학적인 차이를 보이지 않았다. 체중, 보정 전 체질량 지수 및 보정 체질량 지수는 청소년기형 특발성 척추측만증에서 낮았다. 청소년기형 특발성 척추측만증 72예의 요추부 및 대퇴 경부의 골밀도는 대조군에 비해 낮았으며, 대전자부와 Ward 삼각부에서는 차이가 없었다. 결론: 청소년기형 특발성 척추측만증에서 체중, 체질량 지수, 요추부와 대퇴경부의 골밀도는 낮았다. 청소년기형 특발성 척추측만증에서 체중, 체질량 지수 및 골밀도 감소의 원인과 조기 치료 효과에 대한 추가 연구가 필요할 것으로 판단되었다. Purpose: To compare the anthropometric parameters, including weight, height, body mass index and bone mineral density in patients with adolescent idiopathic scoliosis, with those in age- and gender-matched controls. Materials and Methods: The weight, height, body mass index and bone mineral density of 72 girls, aged 11-14 years, and newly diagnosed with adolescent idiopathic scoliosis were compared with 54 age-matched female control subjects. The bone mineral density of the lumbar spine, non-dominant femoral neck, greater trochanter and Ward's triangle were measured using dual-energy X-ray absorptiometry. Results: The average age of the 72 adolescent idiopathic scoliosis patients and 54 controls were 12.9 years and 13.1 years, respectively. There was no significant difference in age between the 2 groups. The weight, uncorrected and corrected body mass index, as well as the bone mineral density of the lumbar spine and femoral neck were significantly lower in the adolescent idiopathic scoliosis patients than those of the controls. There were no significant differences in bone mineral density of the greater trochanter and Ward's triangle between the 2 groups. Conclusion: The weight, body mass index and bone mineral density of the lumbar spine and femoral neck in the adolescent idiopathic scoliosis were significantly lower than the controls. Further studies will be needed to determine the cause and early treatment effects of the low weight, body mass index and bone mineral density in patients with adolescent idiopathic scoliosis.

Tc-99m MIBI , Tc-99m Tetrofosmin , 그리고 Tc-99m ( V ) DMSA 스캔에 의해 발견된 재발성 악성 흉선종

석주원(Ju Won Seok),김성장(Seong Jang Kim),김인주(In Ju Kim),김용기(Yong Ki Kim) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.4

Thymoma is the most common primary tumor of anterior mediastinum, accounting for 20% to 30% of all mediastinal tumors. The recurrence rate after total resection of the thymoma ranges 8% to 18%. We reported one patient of recurrent malignant thymorna imaged with Tc-99m MIBI, Tc-99m Tetrofosmin and Tc-99rn (V) DMSA. Early and delayed Tc-99m MIBI and Tc-99m Tetrofosmin scintigraphies showed an increased uptake in the mediastinal area. Also, Tc-99m (V) DMSA scintigraphy revealed an increased uptake in the corresponding area. Coronal SPECT images of Tc-99m MIBI, Tc-99m Tetrofosmin and Tc-99m (V) DMSA revealed increased uptake of each radiopharmaceutical in the tumor lesion corresponding to the mediastinal lesion on the chest CT. However, the normal blood pool activities of the heart and great vessels of Tc-99m (V) DMSA obscured the recurrent malignant thymoma. Although Tc-99m (V) DMSA is a useful tumor seeking agent, we recommend Tc-99m MIBI and Tc-99rn Tetrofosmin SPECT rather than Tc-99m (V) DMSA to detect primary and recurrent malignant thymoma. (Korean J Nucl Med 2001;35:268-273)

활동성 폐결핵의 판정에서 99mTc-MIBI 의 유용성

김용기(Yong Ki Kim),김인주(In Ju Kim),이효진(Hyo Jin Lee),전두수(Doo Soo Cheon),유석동(Seok Dong Yoo),이민기(Min Ki Lee),박순규(Soon Kew Park),김성장(Seong Jang Kim) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.1

N/A The use of radiopharmaceuticals in evaluation of pulmonary tuberculosis may help to resolve difficult diagnostic problems such as discordance between sputum examinations and chest roentgenographic findings. We investigated the usefulness of 99mTc-methoxyisobutylisonitrile(MIBI) scintigraphy in the detection of active pulmonary tuberculosis. Forty-six patients with suspected active pulmonary tuberculosis were studied with sputum smear of AFB, sputum AFB culture, chest X-ray and MIBI scan. MIBI image was obtained 15 and 60 min after intravenous injection of 370MBq(10mCi) 99mTc-MIBI. In 16 patients of them Ga scans were performed in addition to MIBI scan. Repeated MIBI scans were done in 7 patients with active pulmonary tuberculosis after 4∼6 months of antituberculous chemotherapy. Thirty-two patients were confirmed as active tuberculosis by sputum culture. Sensitivity of MIBI scan to active tuberculosis was 87.5%(28/32) and MIBI findings were negative in all of 14 patients with inactive disease. Focal uptake of MIBI was dense in the area that was strongly suggested active tuberculous lesions by chest roentgenogram. There was no discordance between MIBI and Ga image in 16 patients. But the uptake areas of Ga images were broader than that of MIBI images. After 4∼6 months of antituberculous treatment all repeated MIBI scans revealed negative findings except 1 patient with persistent active pulmonary tuberculosis due to drug resistance. MIBI scan could be used in the detection of active pulmonary tuberculosis as a useful noninvasive diagnostic tool.

유방암의 진단에서 유방초음파 검사와 99mTc - MIBI 유방스캔의 비교

석주원(Ju Won Seok),김성장(Seong Jang Kim),곽희숙(Hi Suk Kwak),이준우(Jun Woo Lee),김인주(In Ju Kim),김용기(Yong Ki Kim),배영태(Young Tae Bae),김동수(Dong Soo Kim) 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.3

목적: 원발성 유방암을 진단하는데 있어서 유방초음파검사와 ^99mTc-MIBI 유방스캔이 유용하다고 평가받고 있다. 그러나 유방초음파 검사는 특이도가 낮다는 문제점을 가지고 있다. 이에 본 연구에서는 유방암 진단에 있어서의 유방초음파 검사와 ^99mTc-MIBI 유방스캔의 진단적인 유용성을 비교해 보았다. 대상 및 방법: 본 연구에서는 1999년에서 2000년 사이에 의심되는 유방 종물에 대해서 유방초음파검사와 ^99mTc-MIBI 유방스캔을 시행했던 174명의 환자를 대상으로 하였다. 모든 환자의 병리조직학적인 결과는 수술이나 미세흡인세포진 검사에 의해서 얻어졌다. 결과: 174명의 환자 중에서 악성질환으로 진단받은 경우는 117명이었고, 양질환성을 진단받은 경우는 57명이었다. 유방초음파 검사의 판독은 88명의 진양성, 9명의 위음성, 8명의 위양성,34명의 진음성, 그리고 35명의 미확정의 결과를 보여 주었다. ^99mTc-MIBI 유방스캔의 판독은 91명의 진양성, 26명의 위음성,9명의 위양성,그리고 48명의 진음성의 결과를 보여주었다. 유방초음파 검사에 의한 민감도, 특이도, 양성예측율, 음성예측율은 각각 66.7%, 44.2%, 67.2%, 그리고 43.6%였다. ^99mTc-MIBI 유방스캔에 의한 민감도, 특이도, 양성예측율, 음성예측율은 각각 77.8%, 84.2%, 91% 그리고 64.9%였다. 유방초음파 검사에 의해서 미확정으로 판독된 35명의 환자에 대해서 ^99mTc-MIBI 유방스캔은 13명의 진양성, 15명의 진음성, 그리고 7명의 위양성의 결과를 보여주었다. 결론: 원발성 유방암을 진단하는데 있어서 유방초음파 검사보다 ^99mTc-MIBI 유방스캔의 민감도와 특이도가 훨씬 더 높고, 유방초음파 검사에 의해서 정확히 결론지을 수 없었던 경우에도 ^99mTc-MIBI 유방스캔은 훨씬더 유용한 정보를 제공해 준다. Purpose:Ultrasonography and ^99mTc-MIBI scintimammography were validated as useful diagnostic tools for primary breast cancer. However, ultrasound has the problem of low specificity. We compared the diagnostic usefulness of ultrasound with ^99mTc-MIBI scintimammography in the diagnosis of breast cancer. Materials and Methods: This study included 174 patients who had ultrasound and ^99mTc-MIBI scintimammography performed on breast masses from 1999 to 2000. The pathologic resuts were obtained by surgery or FNAB. Results: Among the 174 patients, malignant breast disease numbered 117 and benign breast disease numbered 57. Ulutasound revealed 88 TP,9 FN, 8 FP, 34 TN, and 35 indeterminate cases. ^99mTc-MIBI scintimammigraphy revealed 91 TP, 26 FN, 9 FP, and 48 TN. The sensitivity, specificity, positive predictive value, and negative predictive value of Uitrasound were 66.7%, 44.2, 67.2%,and 43.6% respectively. The sensitivity, specificity. positive predictive value. and negative predictive value of ^99mTc-MIBI scintimammography were 77.8%, 84.2%, 91%. and 64.9% respectively. Among the 35 indeterminate ultrasound cases. ^99mTc-MIBI scintimammography revealed 13 TP, 15 TN, and 7 FP. Conclusion: ^99mTc-MIBI Scintimammography was more sensitive and specific than ultrasound for the detection of primary breast cancer and provided more useful information in cases of indeterminate ultrasound findings. (Korean J Nucl Med 2002;36;177-84)

연부 조직 육종에서 18-FDG PET CT의 유용성

김정일(Jeung Il Kim),오종석(Jong Seok Oh),서근택(Kuen Tak Suh),문태용(Tae Yong Moon),이인숙(In Sook Lee),최경운(Kyung Un Choi),김성장(Seong Jang Kim) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.3

목적: 최근 연부 조직 종양의 전이에 대한 진단 및 양성종양과 악성종양을 PET CT를 이용하여 감별하려는 시도가 많아지고 있다. 저자들은 본 연구를 통하여 연부 조직 종양에서 18-FDG PET CT의 유용성을 평가하고자 한다. 대상 및 방법: 악성연부 조직 종양이 의심되어 PET CT를 촬영한 64예를 대상으로 하였으며, 이 중 15예는 양성, 34예는 악성, 15예는 염증성병변이었다. 모든 환자들은 18-FDG CT촬영 후 수술적 치료가 이루어졌으며, 제거된 모든 조직은 수술 후 조직검사로 확진되었다. 반정량적 분석을 위하여 Maximal standard uptake value (SUVmax)를 구하였으며, SUVmax를 ROC 분석, Mann-Whitney test를 이용하여 통계처리 하였다. 결과: 연부조직종양에서 SUVmax 값을 이용하여 양성종양과 악성종양의 구분이 가능하였나, 종양의 등급간 SUVmax 값은 통계적 유의성이 없었다. 그리고 악성종양과 감염을 동반한 연부조직병변의 SUVmax값 역시 통계적 유의성이 없었다. 결론: PET CT는 연부 조직 육종의 국소 재발 및 전이를 진단하는데 도움을 줄 뿐만 아니라 양성종영과 악성종양을 감별하는데 유용한 핵의학영상 장치로 사료된다. 그러나 염증을 동반하는 경우나 염증성 병변이 의심될 경우 진단에 유의를 하여야 할 것으로 사료된다. Purpose: Recently, there have been many attempts to use PET-CT for the diagnosis of metastasis of soft tissue tumors and for differentiating benign tumors from malignant tumors. In this study, we wanted to evaluate the efficacy of 18-FDG PET CT in soft tissue tumors. Materials and Methods: Patients (n=64) with suspected malignant soft tissue tumor had 18-FDG PET CT scans This included 15 cases of benign soft tissue tumor, 34 cases of malignant soft tissue tumor and 15 cases of inflammatory lesions. All patients went through surgical treatment after PET-CT imaging was done, and all dissected tissues were biopsied. For semiquantitive analysis, SUVmax(Maximal standard uptake value) was measured, and SUVmax was determined using ROC analysis, the Kruskal-Wallis test and the Mann-Whitney test. Results: Using 18-FDG PET CT it was possible to differentiate benign from malignant tumor using SUVmax values. But. discrimination between different grades of tumor was not possible. Also discrimination between malignant tumors and inflammatory lesions was not possible. Conclusion: PET-CT can be considered as a useful nuclear imaging method that can detect local recurrence and distant metastasis of soft tissue sarcoma and can differentiate benign from malignant tumors. But PET-CT results must be interpreted carefully in diagnoses when there is inflammatory disease or a suspected lesion present.

폐암환자에 있어 CT상으로 진단된 폐림프관성암종증의 형태에 따른 F-18 FDG 섭취의 차이

전성민 ( Sung Min Jun ),김용기 ( Yong Ki Kim ),김인주 ( In Ju Kim ),김성장 ( Seong Jang Kim ),남현열 ( Hyun Yeol Nam ),김범수 ( Bum Soo Kim ) 대한핵의학회 2008 핵의학 분자영상 Vol.42 No.4