경동맥 죽상경화반의 고해상도 자기공명영상

변우목,조재호 영남대학교 의과대학 2004 Yeungnam University Journal of Medicine Vol.21 No.2

A thromboembolic stroke is believed to be precipitated by a rupture of vulnerable atheromatous plaques. Until recently the assessment of a further risk of stroke in high-risk patients in whom atherosclerosis has presented with a transient ischaemic attack (TIA), has been confined to a quantitative assessment of the luminal patency of the internal carotid artery. These traditional stratification parameters are no longer believed to be the most accurate predictors of a thrombo-ernbolism. This is because the process of vessel wall remodeling can maintain a luminal patency, and consequently, quite large friable plaques may remain unidentified. Accordingly, there is a need for an improved risk assessment. The fibrous cap of a vulnerable plaque is thinner, and an intraplaque hemorrhage and inflammation can occur during the development of atherosclerotic plaque. Several imaging methods for identifying vulnerable plaques have been developed. Recently, high resolution magnetic resonance (MR) imaging has emerged as an accurate non-invasive tool that can characterize the carotid plaque components in vivo. A High resolution carotid magnetic resonance is capable of distinguishing an intact, thick fibrous cap from a thin and ruptured cap in carotid plaque. In addition, a plaque MR can identify the active inflammation and detect a hemorrhage. High resolution carotid MR imaging is a valuable noninvasive method for quantifying the plaque components and identifying vulnerable plaque.

성인에서 식도폐쇄를 동반하지 않는 (H-type) 선천성 기관식도루 1 예 보고

변우목 대한영상의학회 1986 대한영상의학회지 Vol.22 No.4

Congensital tracheoesophageal fistula with no esophageal atresia is considered a rare type anomaly, especially in adult age. We report a cases of isolated tracheoesophageal fistula with no esophageal atresia with review of literature.

Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography

변우목,김재운,이재교 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.4

Objective: To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. Materials and Methods: The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. Results: Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. Conclusion: Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra. Objective: To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. Materials and Methods: The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. Results: Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. Conclusion: Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra.

난소 악성 생식세포종의 전산화 단층촬영 소견

변우목,조길호,박본환 영남대학교 기초/임상의학연구소 1993 Yeungnam University Journal of Medicine Vol.10 No.2

망막아세포종의 전산화 단층촬영 소견

변우목 대한영상의학회 1987 대한영상의학회지 Vol.23 No.1

Authors retrospectively analayzed CT findings of 10 findings of 10 cases which proved retinoblastoma by pathology from may in 1983 to August in 1986 at Yeungnam univ. hospital. RESULT: 1. The age at time of diagnosis was 1-5 year old. 2. In 9 cases, retinoblatoma was unilateral. 3. Of all 10 cawses, 8 cases revealed intraocular calcification. 4 At time of diagnosis of retinoblastoma, optic nerve involvement with or without intracranial extension were 2 cases. The diagnosis of retinoblastoma can be made clinically, but CT is valuable adjunct in differential diagnosis and mangement as well as diagnosis of retinoblastoma. In addition, orbital CT can be used to determine if there is retrobubal extension of retinoblastoma, involvement of CNS, and development of secondary orbital tumors.

Congenital Cytomegalovirus Infection of the Brain: MR Imaging and Ultrasonographic Findings of Paraventricular Cysts

변우목,황미수,Byeon, U-Mok,Hwang, Mi-Su The Korean Radiological Society 2002 대한영상의학회지 Vol.47 No.1

목적:선천성 cytomegalovirus (CMV)감염 의 신경방사선학적 소견은 잘 알려져 있지만 뇌를 침범하는 선천성 CMV 감염을 가진 환자에서 발생되는 뇌실주위 낭종의 영상소견에 대한 보고는 흔하지 않다.이 연구의 목적은 MR 과 초음파영상에서 나타난 뇌실주위 낭종의 형태에 대해 보고하고 자 한다. 대상과 방법:뇌를 침범한 선천성 CMV 감염을 가진 환자 10명의 MR과 초음파 소견을 후향적으로 분석하였다.소변의 바이러스 배양에서 양성인 4명,CMV IgM 양성인 4명과 IgG 양성인 두 명에서 전형적인 자기공명영상소견으로 진단하였다.초기 자기공명영상은 10명에서 초기초음파는 뇌실주위낭종을 가진 5명중 4명에서 시행되었다.뇌실주위낭종의 변화를 평가하기위해 추적 자기공명영상과 초음파소견은 3명의 환자에서 시행되었다.뇌실주위낭종의 크기,위치,양 측성,그리고 형태를 평가하였다. 결과:뇌실주위낭종은 10명의 환자 중 5명 (50%)에서 발견되었다.모든 뇌실주위낭종은 양측성이었다.뇌실주위낭종의 크기는 10-23 mm (평균 15 mm)였다.뇌실주위낭종의 위치는 Monro공 주위에 3예,후두각주위 1예,그리고 측두각주위 1예였다.MR영상에서 뇌실주위낭종의 액체는 T1 강조영상에서는 저신호강도,T2강조영상에서는 고신호강도로 뇌척수액과 비슷하였다.초음파 검사를 시행하여 뇌실주위낭종의 소견은 다양하였는데 순수한 낭종은 1예,두터운 낭종벽과 격막을 가진 낭종은 1예,그리고 복잡한 내용물을 가진 낭종들은 2예였다.3증례에서 추적 MR과 초음파 검사를 시행하였고 뇌실주위낭종은 모두 4개월에서 23개월 후에 사라졌다. 결론:MR에서 뇌실주위낭종은 순수한 낭종으로 보이지만 초음파 소견에서는 복잡한 내용물(complicated contents)혹은 격막이 나타날 수 있다.흉부 촬영은 비정상 소견이 26예였고 정상 소견이 10예였다. 정상단순 흉부촬영소견을 보인 예중 7예는 유방 및 흉벽의 접면조사만 시행하였고 이 중 3예의 CT에서 선상 혹은 흉막하 간유리 음영을 보였다. 정상 단순 흉부 촬영 소견을 보인 예 중3예는 액와 및 쇄골상 림프절 전면 추가 조사를 받은 환자로 이 중 2예의 CT에서 선상 혹은망상형의 음영을 보였다. 결론: 유방암 환자의 방사선 치료 후 CT 소견은 방사선 치료의 방법에 따라 폐첨부 혹은 폐의전면 흉막하 부위에 선상 혹은 망상형의 음영으로서 방사선 폐렴 혹은 섬유화 소견이다. CT는 단순 흉부 촬영보다 이상 소견의 발견이 쉽다.이러한 소견은 후에 합병될 수 있는 다른 폐질환의 감별 진단에 도움이 될 것으로 보인다.moembolization via the radial artery approach were involved in this study. All underwent Allen’s test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating t\ulcorner selec\ulcorneron ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. Results: Except for three in which Purpose: Although the neuroradiological findings of congenital cytomegalovirus (CMV) infection are well known, little has been reported concerning the imaging findings of paraventricular cysts occurring in patients with cytomegalovirus infection involving the brain. The purpose of this study is to describe the features of paraventricular cysts observed at MRI and ultrasonography. Materials and Methods: MR and ultrasonographic studies of ten patients with congenital cytomegalovirus infections involving the brain were retrospectively reviewed. Diagnosis was confirmed by positive culture of the virus in urine (n=4), the presence of CMV Ig G antibody (n=4), or positive CMV Ig M antibody (n=2), and on the basis of characteristic MR imaging findings. Initial MRI in all patients and initial ultrasonography in four of five with paraventricular cysts were performed. Three patients underwent follow-up MRI and ultrasonography for the evaluation of cystic change, and the size, location, bilaterality and morphology of the cysts were evaluated. Results: Bilateral paraventricular cysts averaging 15 (range. 10-23) mm in size were found in five of the ten patients (50%). They were adjacent to the foramen of Monro in three cases, the occipital horn in one, and the temporal horn in one. MR imaging showed that the fluid content of all cysts was of similar signal intensity to cerebrospinal fluid (T1-WI, hypointense; T2-WI, hyperintense). The ultrasonographic findings varied: there was one pure cyst and one with a thick wall and septations, and two contained complex fluid. In three patients, follow up MRI and ultrasonography showed that the cysts disappeared after 4-23 months. Conclusion: Although paraventricular cysts may appear at MRI to be purely cystic, ultrasonography may indicate that their contents are more complex, or that septations are present.

뇌열 1예의 기능적 자기공명영상과 경두부 자기자극

변우목,한봉수,이재교,장용민 대한자기공명의과학회 2000 Investigative Magnetic Resonance Imaging Vol.4 No.1

목적 : 뇌열환자에서 기능적 자기공명영상과 경두부 자기자극을 이용하여 뇌기능을 지도화하고자하였다. 대상 및 방법: 자기공명영상에서 우측 대뇌반구에 뇌열 소견이 있으며 좌측 편측부전마비를 보인 28세 남자환자를 대상으로 기능적 자기공명영상과 경두부 자기자극을 시행하였다. 임상적으로 좌측 손의 운동기능은 감소되어 있었고, 우측 손의 운동기능은 정상범주에 속하였다. 뇌기능적 자기공명영상은 EPI 기법을 이용하였고 운동자극은 1-2 Hz의 주기로 손가락을 아래위로 구부리게 하는 운동을 시행하였고 15초의 휴식기와 15초의 운동기를 반복하여 절편당 60 개의 영상을 획득하였다. 두부자기자극은 지름 90mm의 원형 자성자극기를 이용하여 maximal out-put의 80%로 자극하여 양측 단무지 외 전근에서 유발된 운동유발전위의 잠시와 진폭을 구하였다. 결과: 기능적 자기공명영상을 시행한 결과 정상적인 우측손의 운동자극시에 좌측 운동피질이 활성화되었고 좌측손의 운동자극시에는 좌측운동피질, 좌측 부가운동영역, 그리고 자측 전운동영역에 활성화소견이 나타났다. 두부자기자극에서는 우측 대뇌반구에서는 한군데에서도 운동유발 전위가 발생되지 않았다. 좌측 대뇌반구에서는 5군데에서 운동유발전위가 유발되었으며 모두 양측 단무지 외 전근에서 운동유발전위가 유발되었다. 양손에서 운동유발전위의 잠시 , 진폭 모양이 유사하였다. 결론: 뇌열환자의 손운동기능의 피지도화는 기능적 자기공명영상과 두부자기자극을 이용하여 성공적으로 시행할 수 있었다. 뇌열환자의 동측 운동경로는 동일한 운동피질로부터 기원한 동측피질척수로에 의한 것으로 추정된다. Purpose : This study was to present the functional brain mapping of both functional magnetic resonance imaging(MRI) and transcranial magnetic stimulation(TMS) in a case of schizencephaly. Materials and methods : A 28-year-old man, who had left hemiplegia and schizencephaly in right cerebral hemisphere, was exacted with both functional MRI and TMS. Motor function of left hand was decreased whereas right hand was within normal limit. For functional MRI, gradient-echo echo planar imaging($TR/TE/{\alpha}$=1.2 sec/90 msec/90) was employed. The paradigm of motor task consisted of repetitive self-paseo hand flexion-extension exercises with 1-2 Hz periods. An image set of 10 slices was repetitively acquired with 15 seconds alternating periods of task performance and rest and total 6 cycles (three ON periods and three OFF periods) were performed. In brain mapping, TMS was performed with the round magnetic stimulator (mean diameter; 90mm). The magnetic stimulation was done with 80% of maximal output. The latency and amplitude of motor evoked potential(MEP)s were obtained from both abductor pollicis brevis(APB) muscles. Results : Functional MRI revealed activation of the left primary motor cortex with flexion-extension exercises of healthy right hand. On the other hand, the left primary motor cortex, left supplementary motor cortex, and left promoter areas were activated with flexion-extension exercises of left hand. In TMS, magnetic evoked potentials were induced in no areas of right cerebral hemisphere, but in 5 areas of left corebral hemisphere from both abductor pollicis brevis. Latency, amplitude, and contour of response of the magnetic evoked potentials in both hands were similar. Conclusion : Functional MRI and TMS in a patient with schizencephaly were successfully used to localize cortical motor function. Ipsilateral motor pathway is thought to be secondary to reinforcement of the corticospinal tract of the ipsilateral motor cortex.

기계적 분리코일(MDS coil)을 이용한 소아 거대 중대뇌동맥류의 치료

최광식,김성호,배장호,김오룡,최병연,조수호,변우목 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

A 14-year old boy was admitted with stuporous mentality. CT scan, MRI and cerebral angiogram revealed SAH and a giant aneurysm of right middle cerebral artery(4x5x5.3cm). To minimize surgical risk, endovascular treatment was done with MDS(mechanical detachable system)-spiral coil. Follow up MRI showed intraluminal thrombus formation of the aneurysm.

드문(Uncommon) 유방암의 방사선학적 소견

김재운,안재홍,황미수,이재교,변우목 영남대학교 의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.1

영남대학교 의과대학 부속병원에서 1989년부터 1996년까지 유방암으로 확진된 512례 중 드문 유방암은 34례(6.64%)로 점액성암종 14례, 수질성암종 9례, 림프종 4례, 악성엽상육종 3례, 전이성 소세포암 2례, 혈관육종 1례, 평활근육종 1례였다. 드문 유방암 21례의 단순유방촬영 소견은 군집성 미세석회화 소견을 보이지 않는 경우 20례, 변연이 분명한 경우 13례, 모양이 둥글거나 구형인 경우 9례로 양성종양과 유사한 소견을 보였다. 종괴가 다발성인 5례 모두 원발성 림프종과 전이성 유방암이였으며 크기는 1cm에서 3cm까지가 위치는 상외측이 가장 많았다. 12례의 초음파 소견은 둥글거나 구형 또는 분엽성의 규칙적인 모양이 10례, 매끈하고 고른 경계가 9례, 뚜렷한 측면에코 7례, 후방에코 증강이 11례로 모양, 경계, 측면에코, 후방에코 등은 양성을 시사하는 소견을 보였으나 비균질성의 내부에코 7례, 거칠고 두꺼운 주변부에코 8례, 종괴의 폭/깊이의 비율이 1.5이하 11례로 내부에코, 주변부에코, 폭/깊이의 비율등은 악성을 시사하는 소견을 보였다. 결론적으로 드문 유방암은 단순유방촬영상 양성 소견을 보이나 초음파영상에서 주변부에코, 내부에코, 폭/깊이 비율등은 악성을 시사하는 소견을 보여 진단에 주위를 요한다. We analyzed the mammographic (n=21) findings (location, margin, shape, cluster microcalcifications, size, multiplicity) and ultrasonographic (n=12) findings (shape, border, internal echo, boundary echo, posterior echo, lateral echo, width/depth ratio) to evaluate specific radiologic findings of histopathologically proved uncommon breast cancer. The mammographic findings (n=21) are as follow; 1) single; 16, multiple; 5 2) margin (smooth; 13, irregular; 4, spiculated; 4) 3) shape (round and ovoid; 9, lobulated; 8, irregular; 4) 4) cluster microcalcifications (abscent; 20, present; 1) 5) size (1-3cm; 18, 3-5cm; 2, 5cm> ; 1) 6) location (UOQ; 13, UIQ; 4, LIQ;3, LOQ; 1). The ultrasonographic findings (n=12) are as follow; 1) shape (round to oval; 5, lobulated; 5, irregular; 2) 2) border (smooth even; 9, rough uneven; 3) 3) internal echo (fine homogeneous; 5, coarse heterogeneous; 7) 4) boundary echo (regular fine; 4 irregular thick; 8) 5) posterior echo (enhanced; 11, no change; 1) 6) lateral echo (marked; 7, nonexistent; 5) 7) width/depth ratio (1.5>; 1, 1.0-1.5; 7, 1.0< ;4). Uncommon breast cancer show benign nature on mammogram, but malignant nature on ultrasonogram (especially boundary echo, internal echo, width/depth ratio).

소아복부 종괴의 방사선학적 고찰

변우목,권혁포,황미수,장재천,김선용,박복환 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.1

최근 5년간의 소아의 복부종과 23예를 발생빈도, 부위 및 방사선학적 소견을 중심으로 비교분석하여 다음과 같은 결론을 얻었다. 1. 전체 23예중 신경아세포종이 6예로 가장 많았고, 그 다음이 Wilms'종양 5예, 담도낭종, 난소종양, 수전증 등의 순위였다. 2. 발생연령별로 분석해 본 결과 6세 이하가 78%(14예)를 차지했고 특히 후복강 종양은 6세 이하에 집중되어 있었다. 3. 부위별로는 후복강 종양이 60%(14예)로 가장 많았다. 4. 방사선학적 소견을 분석하여 본 결과 1) 단순 복부촬영상 신경아세포종의 50%에서 특징적인 석회화 음영을 볼 수 있었고 후복강 종양의 대부분에서 비특이적인 석회화 음영을 볼 수 있었다. 2) 초음파 소견상 저에코, 고에코 또는 혼합에코 등의 종괴 내부성장을 알 수 있었으나 종괴의 정확한 해부학적 위치를 파악할 수 없는 경우가 많았다. 3) 경정맥 신우 조영촬영상 신우신배의 비정상적인 소견과 신장의 전위소견으로부터 신장내 종양과 신장외 다른 부위의 종양을 구분할 수 있었다. 4) 전산화 단층촬영상 종괴 내부의 성상뿐만 아니라 종괴의 해부학적인 위치, 주위 구조와의 관계, 임파절이나 다른 부위로의 전이유무를 알 수 있었다. The abdominal tumors in children are different from those of adult. These tumors are the third most common one, preceded by leukemia and brain tumors, in children under 15 years. X-ray examination is the most important method among diagnostic approaches. The role of diagnostic imaging is to identify the precise anatomic location and extent of pathologic process with the minimal number of imaging procedures. 23 cases of abdominal tumors were reviewed in respect of age incidence, site of origin, radiologic findings. The results are briefly summarized as follows: 1. Neuroblastoma was the most common(6cases) and wilm's tumor(5 cases), choledocal cyst(4 cases), ovarian mass(3 cases), hydronephrosis(2 cases), were descending order in frequency. 2. The most common site was retroperitoneum(60%) Kidney was the single most common site of origin. 3. Radiologic findings. The most common findings of plain radiography was ill defined soft tissue mass and this method was helpful in the presence of calcification especially in neuroblastoma. Ultrasonographic pattern was anechoic(cystic), echoic or mixed pattern, but this method provide less precise anatomical details, nevertheless ultrasonography was paticullary useful imaging modality for the pediatric abdominal tumors. IVP findings were renal displacement, caliceopelvic system distortion or nonvisualization of kidney, these information was helpful in determining the location of tumors. CT scan showed homogenous or inhomogenous, cystic or solid, mass with their anatomic location. 4. Ultrasonography was the most widely used specific diagnostic method, but had limited value in detecting the anatomic location of tumors. CT scan was superior to ultrasound for determining the extent of tumors.