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64절편 다검출기 CT 관상동맥 조영술을 이용한 관상동맥 질환 진단의 정확도
남궁준 ( June Namgung ),최현민 ( Hyun Min Choe ),권성욱 ( Sung Uk Kwon ),도준형 ( Joon Hyung Doh ),이성윤 ( Sung Yun Lee ),허감 ( Gham Hur ),이원로 ( Won Ro Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1
목적: 관상동맥 질환의 진단에 있어서 현재까지 가장 정확한 방법은 고식적 관상동맥 조영술(conventional coronary angiography)이었다. 다검출기 CT (multidetector computed tomography, MDCT) 관상동맥 조영술은 1999년에 처음 등장한 이래로 빠른 기술적 진보를 보여 최근에 임상에 도입된 64절편 MDCT는 공간 및 시간해상도를 더욱 향상시켜 비관혈적으로 관상동맥 영상을 보다 정확히 규명하기에 이르렀다. 이에 본 연구에서는 64절편 MDCT를 사용하여 MDCT 관상동맥 조영술의 진단 정확도를 확인하여 기존의 관혈적 관상동맥 조영술을 대치할 수 있는지 판정하였다. 방법: 고식적 관상동맥 조영술이 예정된 101명(남자 63명, 여자 38명; 평균연령 63.7±10.5세)을 대상으로 MDCT와 고식적 관상동맥 조영술을 7일 이내에 시행하였다. 관상동맥 각 분절의 유의한 협착은 관상동맥 내경의 50% 이상 협착으로 정의하여 고식적 관상동맥 조영술의 영상과 비교하여 MDCT의 진단적 정확도를 측정하였다. 관상동맥의 유의한 협착정도를 각각 관상동맥의 분절별, 혈관별, 환자별로 구분하여 판정하였다. 결과: 총 1,440개의 관상동맥분절 중 1,348개의 분절(94%)이 MDCT로 분석 가능한 영상을 얻을 수 있었고 이중 고식적 관상동맥 조영술에서 209개의 관상동맥 분절의 유의한 협착이 있었다. MDCT의 진단정확도는 민감도, 특이도 양성예측도, 음성예측도가 분절별 평가에서 각각 96%, 97%, 85%, 99%, 혈관별 평가에서 각각 99%, 95%, 88%, 99%, 환자별 평가에서 각각 100%, 94%, 97%, 100%였다. 위양성이 37분절에서 있었고 관상동맥 석회화(26분절)가 위양성의 주요 원인이었다. 결론: 본 연구에서 64절편 MDCT 관상동맥 조영술은 높은 진단정확도를 보였다. 따라서 선택적인 환자에서 불필요한 관혈적 관상동맥 조영술의 시행을 줄이고 이를 대치할 수 있는 유용한 검사로 판단된다. Background/Aims: Invasive coronary angiography remains the gold standard in the diagnosis of coronary artery disease. However, multidetector CT (MDCT) coronary angiography is an emerging technique that is available for the non-invasive detection of coronary artery stenoses. While the diagnostic accuracy of first generation MDCT is limited, recently released 64-slice MDCT has yielded promising results due to increased temporal and spatial resolution. The objective of this study was to investigate the diagnostic accuracy of non-invasive 64-slice MDCT for coronary artery disease. Methods: One hundred one patients (63 males and 38 females; mean age, 63.7±10.5 years) undergoing conventional coronary angiography were included in this study. All coronary arteries, including the distal segments and side branches, were analyzed for the presence of significant stenosis (≥50% diameter stenosis) and compared with of the quantitative coronary angiographic findings. Results: Of the 1,440 coronary artery segments studied, 1,348 segments were assessed quantitatively by both MDCT and conventional coronary angiography (94%). Two hundred nine significant stenoses were detected by conventional coronary angiography. On a segment-based analysis, the senisitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. On a vessel-based analysis, the sensitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. The corresponding values obtained on a patient-based analysis were 100, 94, 97, and 100%, respectively. Coronary calcification was the major cause of false-positive findings. Conclusions: This study demonstrated that 64-slice MDCT coronary angiography is of similar accuracy as conventional coronary angiography for the detection of coronary artery disease. In selected groups of patients, 64-slice MDCT may replace the more invasive coronary angiography. (Korean J Med 75:42-53, 2008)
에나멜 상피종성 및 유두상 두개인두종의 임상상과 자기공명영상 ( MRI ) 소견의 비교
강태욱,양태영,김광원,이문규,민용기,이명식,정재훈,김종현,나동규,정인경,함종렬,권성욱,조건영,이지민,배문희,서연림,유재욱 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.2
Background : Craniopharyngioma is a suprasellar or intrasellar epithelial neoplasm that occurs in both children and adults. It accounts for 1.2 to 3 % of intracranial tumors with an incidence of 0.5 to 2 cases per one million populations each year. Recently, it has been postulated that it may have two pathogenetically separate subtypes, which are adamantinous and papillary craniopharyngioma, and that their clinical features may be different. However, there are some disagreements in this postulation. Therefore, we studied 22 consecutive patients with craniopharyngioma to evaluate the differences in clinical features and MRI findings between two subtypes. Methods : We studied 22 patients with histologically proven craniopharyngioma after surgery at Samsung Medical center from 1995 to 1999. Thirteen patients were male, and nine patients were female. The average age was 30 years, with a range from 1 to 58 years. We divided 22 patients into two histopathologically separate subtypes; adamantinous and papillary subtypes. We compared the clinical features and MRI findings of two subtypes by reviewing medical records. Results : Out of 22 patients with craniopharyngioma, 19 patients had an adamantinous subtype and 3 patients had a papillary subtype. The adamantinous subtype occurred frequently in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype located in suprasellar or intrasellar portion as well as extrasellar portion, while the papillary subtype was restricted to the suprasellar location. The average tumor size of the adamantinous subtype was 3.7 cm, with a range from 1.4 to 6.0 cm, which was larger than that of the papillary subtype (average size 1.8 cm with a range from 1.5 to 2.3 cm, p $lt; 0.05). The adamantinous subtype was predominantly cystic, while the papillary subtype was predominantly solid (p $lt; 0.05). There were no significant differences in the preoperative clinical features and the postoperative complications between two subtypes. Conclusion : The adamantinous subtype had two peaks of occurrence in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype was larger and had cystic portion, while the papillary subtype was smaller and had solid portion. The preoperative clinical features and the postoperative complications between two subtypes seemed not to be different (J Kor Soc Endocrinol 15:170-178, 2000).