X-선사진 증례별 판독 포인트 : 골질환

설혜영 동아엑스선기계 방사선기술연구소 1995 화상연구 Vol.3 No.1

파노라마 촬영시 두개골위치에 따른 하악골의 수평 및 수직확대에 관한 연구

설혜영,서원혁,신상완 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.3

The Panoramic radiography is the most useful method for the delineation of the mandible and facial bones, because it converts easily the curved structures into the flat image. But the image of the panoramic radiogram causes the magnification and distortion of the anatomic structures. The most important point on the panoramic radiogram was the correct position of the head of the patient. The purpose of this study was to identify the horizontal and vortical magnification rates of the mandible examined on the standard position and the different changes of the horizontal and vertical magnifications of the mandible on the panoramic radiography according to the forward and backward frontal movements. After 2 midline and 8 bilateral locations on each sides were selected at a mandible of a dry skull, total 18 metal balls were attached correctly at the mandible. Total 8 dry skulls were prepared. Then 5 panoramic films per each dry skull (40 films per 8 dry skulls) were taken at the standard position and 4 moved positions (2 forward and 2 backward frontal movements on the sagittal axis with 1cm apart) The results were as follows: 1. On the standard position, total average horizontal magnification rate of the mandible was 110.6% and vertical magnification rate, 115.2%. The distribution of horizontal magnification rates at the 10 selected locations showed many varieties and vertical, little varieties. Most magnified location was the lower border of the mandible including the lower symphysis horizontally and the mandibular body vertically. The central incisor and the coronoid process were reduced in these horizontal diameters. 2. Both intercondylar distance was small as compared with both interangular distance on the forward frontal movement, and large on the backward frontal movement. 3. The magnification and distortion of the image on the backward frontal movement were more great as compared with the forward frontal movement. 4. The most changeable location of the magnification and distortion according to the frontal movements was the central incisor area. Because of the narrow focal trough (the area of sharpness) at the incisor area, the incisor showed the reduction in the horizontal diameter. The panoramic radiograms taken on the incorrect forward or backward frontal positions cause the prominent different changes of magnification and distortion of the mandible, so the correct position of the head is the most important point for the panoramic radiogram. And another important point was the recognition of the different magnification characteristics of each panoramic apparatus on each locations of the mandible.

GDC를 이용한 뇌 동맥류의 방사선학적 치료법

설혜영,변홍식,최인섭 고려대학교 의과대학 1995 고려대 의대 잡지 Vol.32 No.2

A new method of the endovascular occlusion of the cerebral aneurysm using detachable coil called by GDC(Guglielmi detachable coil) has been developed by Guglielmi in 1991. The mechanisms of GDC treatment are the electrolysis and electrothrombosis. To evaluate the clinical results of GDC treatment, 45 cerebral aneurysms(9 small, 28 large, 8 giant aneurysms) in 42 patients(l0 males, 32 females) were analized. 1 Among total 45 cerebral aneurysms, anterior circulation aneurysms were 28 cases (62.2%) and posterior circulation aneurysms were 17 cases(37.8%). Most common site of cerebral aneurysms was the supraclinoid portion of internal carotid artery (15 cases, 33.3%). The second common site was the tip of basilar artery (6 cases, 13.3%) and the third, the cavernous portion of internal carotid artery(5 cases, 11.1%). 2. Among total 45 cerebral aneurysms, more than 90% occlusions of cerebral aneurysms with GDC were seen in 41 cases(91.1%). 3. Among total 42 patients, 3 patients(7.1%) had major complications by GDC treatment : death due to thrombosis, embolism. arterial dissection. And 3 patients(7.1%) showed temporary arterial occlusions. 4. Among 21 patients who had 6 months follow up study, 17 patients(81.0%) were successful for the treatment and 4 patients(l9.0%) were unsuccessful with coil packing or migration. Endovascular occlusion of cerebral aneurysm with GDC is the promising new technique. It had more advantages compared with the detachable ballon occlusion ; less stress to the wall of the aneurysm, more complete occlusion of the aneurysm lumen. It can be also an alternative or adjunct method to surgical clipping of the aneurysm.

외상에 의한 일과성 슬개골 외측탈구의 자기공명영상소견

설혜영,김성문,안중모,신명진,Seol, Hye-Yeong,Kim, Seong-Mun,An, Jung-Mo,Sin, Myeong-Jin 대한영상의학회 2001 대한영상의학회지 Vol.45 No.4

목적:임상적으로 외상 후 일과성 슬개골 외측 탈구가 의심되는 대부분의 경우에 방사선과 영역의 검사로는 단순촬영만으로 이루어지며 자기공명영상을 시행하는 경우는 매우 드물다.이에 저자들은 자기공명영상 소견을 분석하고 그 특징을 알아보고자 하였다. 대상과 방법:외상 후 일과성 슬개골 외측 탈구 기왕력이 있고 슬관절 자기공명영상을 시행한 환자 중 비정상 소견을 보인 8명의 환자를 대상으로 하였다.6명의 남자와 2명의 여자 환자로서 평균 연령은 22세이었다.이들 중 5명은 보존적 치료를 받았으며 3명은 관절경을 이용한 수술적 치료를 받았다.두 명의 방사선과 의사가 골 좌상과 연골 결손의 위치,골절 혹은 유리체의 유무,삼출액 종류,동반된 연부 조직의 손상과 슬개골의 아탈구 등을 후향적으로 분석하였다. 결과:골 좌상은 외측 대퇴과 (n=8,100%),슬개골의 내측 관절면 (n=8,100%)과 외측 경골 고평부 (n=3,38%)에 있었다.연골 결손은 슬개골의 내측 관절면 (n=5,63%)에만 있었다.골절은 외측 대퇴과 (n=2,25%)와 슬개골의 내측 관절면 (n=1,13%)에 있었다.유리체는 3예 (38%)에서 있었고 삼출액은 7예 (88%)에서 있었는데,그 중 3예는 지방혈관절증(lipohe-marthrosis)이었다.연부 조직의 손상으로는,내측 슬개골 지대 (medial patellar retinaculum)의 열상 (n=8,100%),전방십자인대 열상 (n=1,13%)과 슬개 인대의 손상 (n=2,25%)등 이 동반되었다.슬개골의 아탈구는 7예 (88%)에서 있었다. 결론:외상 후 일과성 슬개골 외측 탈구의 경우에 자기공명영상을 이용하여 골과 연골,연부 조직의 손상을 잘 알 수 있었다.성병변이 원인질환임을 알 수 있었다.따라서 위점막표면결절화의 방사선학적 소견에 익숙해지는 것이 정확한 진단뿐 아니라 결절화의 범위를 결정하고 추가검사를 권유하는 등의 진단적 가치를 높일수 있다.회화 및 낭성변화는 갑상선암의 림프절 전이를 예측하는데 매우 유용한 지표로 생각된다.(離乳食)이 전무(全無)한 실정(實情)이고 임신부(妊娠婦)나 수유부(授乳婦)를 위(爲)한 보충식(補充食)도 따로 없다.서는 NE는 심박증가(心搏增加)와 혈압상승(血壓上昇)을 일으켰으며, clonidine은 심박(心搏)에는 거의 변동(變動)을 일으키지 않았고 경미(輕微)한 혈압상승(血壓上昇)을 일으켰다. 8) NE 및 clonidine에 의한 심박감소(心搏減少), clonidine에 의한 혈압하강(血壓下降)은 주(主)로 presynaptic ${\alpha}$-adrenoceptor를 중개(仲介)하여 일어나나, NE 및 clonidine에 의한 혈압상승(血壓上昇)은 presynaptic site 이외(以外)의 부위(部位)를 중개(仲介)하여 일어나는것 같다.뇌동맥 직경은 성별에 상관없이 고령층이 저령층에 비하여 의미있게 크거나 큰 경향을 나타내었다. 고령층의 중뇌동맥 근위부 직경은 남자가 2.59$\pm$0.35 mm, 여자가 2.38$\pm$0.37 mm이었고, 원위부 직경은 남자가 2.63$\pm$0.43 mm, 여자가 2.39$\pm$0.35 mm 이었다.고 Monaliza Finely Soft는 23% 더 높은 분리율을 나타냈으므로 선충분리용(線蟲分離用)으로는 향수처리(香水處理)되지 않은 것이 더 좋은 것으로 사료(思料) Purpose: To determine the magnetic resonance (MR) imaging characteristics of traumatic transient lateral dislocation of the patellae. Materials and Methods: In eight patients (6 males, 2 females, mean age: 22.4 years) in whom transient lateral dislocation of the patella was diagnosed, the distinctive MR imaging findings reflecting known injury mechanism were retrospectively analyzed with regard to bone contusion, chondral defect, fracture, loose body, joint effusion, and the associated soft tissue abnormalities. Results: All of eight patients had bone contusions in the lateral femoral condyle and medial facet of the patella, while in five, chondral defects were present in this latter region. In three patients, fractures of the on lateral femoral condyle(n=2) and medial facet of the patella (n=3) were noted, and in three others, loose bodies were noted. Joint effusion [simple effusion (n=4), lipohemarthrosis (n=3)] was observed in seven patients, and associated soft tissue injuries [to the medial patellar retinaculum (n=8), patellar tendon (n=2), and anterior cruciate ligament (n=1)] in eight. Patellar subluxation was found in seven. Conclusion: MR imaging is a useful technique for the diagnosis of traumatic lateral dislocation of the patella. The significant MR findings are bone contusion in the lateral femoral condyle and medial facet of the patella, chondral defect, fracture, joint effusion, injury to the medial patellar retinaculum, and patellar subluxation.

측면경추천자법에 의한 경추척수강조영술

설혜영 대한영상의학회 1985 대한영상의학회지 Vol.21 No.6

Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelogram; 1) Small amount of contrast media 2) Excellent image 3) Less position change 4) Short time 5) Well visualiztion of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media

나선형 전산화단층촬영에서 대상구를 근거로 하는 대뇌 중심전회 및 중심후회의 식별

설혜영,차상훈,이남준 고려대학교 의과대학 1995 고려대 의대 잡지 Vol.32 No.2

Cerebral precentral and postcentral gyri have the important functional areas; Brodmann's area 4(motor area) and 3, 1, 2(sensory area) each other. we can identify easily precentral and postcentral gyri on MR image because precentral, central and postcentral sulci are well visualized. Sometimes we have to investigate the brain anatomy on CT image when MR can't be examined due to the technical, economical causes. Total 100 brain images(58 males, 42 females) taken from spiral CT were investigated and analized; 1. On the basis of lateral sulci (precentral, central and postcentral sulci), precentral and postcentral gyri were easily identified on 61 subjects and poorly identified on 39 subjects. 2. On the basis of cingulate sulcus, precentral and postcentral gyri were easily identified on 91 subjects and poorly identified on 9 subjects. 3. On the basis of both lateral and cingulate sulci, precentral and postcentral gyri were easily identified on 95 subjects and poorly identified on 5 subjects. 4. Under 20 years old, lateral sulci were poorly visualized on 25 subjects and cingulate sulcus were poorly visualized on 8 subjects. 5. Precontrast and contrast CT images were taken on 78 subjects. Lateral and cingulate sulci were better visualized on noncontrast CT than on contrast CT on 16 subjects(20.5%), and they were better visualized on contrast CT than noncontrast CT on 5 subjects (6.4%). On 57 subjects(73.1%), no image difference for the visualizations of lateral and cingulate sulci was noted between noncontrast and contrast CT. In conclusion, precentral and postcentral gyri on the basis of cingulate sulcus can be better identified than on the basis of lateral sulci on spiral CT. The identifications of precentral and postcentral gyri are easier on the basis of both cingulate and lateral sulci.

초음파를 이용한 표재성 신경초종의 분석 : 초음파기기 주파수 및 종양의 변성이 후방음파증강에 미치는 영향 The Influence of Sonographic Frequency and the Degenerative Change of Tumor on the Posterior Acoustic Enhancement

차상훈,설혜영,정규병 고려대학교 의과대학 1994 고려대 의대 잡지 Vol.31 No.2

We retrospectively analyzed the sonographic findings of 18 pathologically proven superficial neurilemmomas in 17 patients during recent 5 years. We evaluated the contuor, size and internal echo pattern of the tumor, the presence of tumor capsule, and the degree of acoustic enhancement behind the tumor. We correlated the posterior acoustic enhancement with the pathologic features. Eighteen tumors showed oval or round in contuor and 9 tumors revealed hypoechoic pattern, 3 tumors revealed homogenously echogenic pattern and 6 tumors revealed heterogenously echogenic pattern. Sixteen tumors showed the capsule of tumor. Fourteen tumors showed posterior acoustic enhancement. Grade Ⅰ posterior acoustic enhancements were noted at 10 MHz transducer examination only and Grade Ⅱ posterior acoustic enhancements were noted at 5 MHz or 7.5 MHz tranducer examination. No definite correlation between hemorrhagic or cystic degenerations of superficial neurilemmomas and Grade Ⅱ posterior acoustic enhancements were noted. The mean size of hypoechoic superficial neurilemmoma was smallest and that of heterogenously echogenic superficial neurilemmoma was largest. We conclude that sonographic exammination was useful for evaluation of superficial neurilemmoma.

Ultrasound Pattern of Abscess Asssociated with Bone Infection : Clinical Significance 임상적 의의

Park, Cheol Min,Seol, Hae Young,Cha, Sang Hoon,Cha, In Ho,Suh, Won Hyuck 고려대학교 의과대학 1994 고려대 의대 잡지 Vol.31 No.2

화농성골감염 13예와 결핵성골감염 5예에서 동반된 연조직 농양을 초음파로 관찰하여 임상적 의의를 찾고자 하였다. 초음파 검사상 화농성 골감염 13예중 12예, 결핵성 5예중 4예에서 골병변과 붙어있는 농양을 관찰하였다. 농양의 두께는 급성화농성인 경우(0.4-0.6cm, 평균 0.5cm)에서 만성 화농성인 경우(0.4-3.6cm, 평균 1.5)나 결핵성인 경우(0.9-4.6cm, 평균 2.2cm)보다 작았다. 농양누공(n=4)과 부골(sequestrum)(n=3)은 만성화농성 골감염에서 관찰되었다. 결핵성인 경우에는 농양의 소방형성(n=2)과, 내부에 미세석회화를 포함하는 수지모양의 농양(n=1)이 보였다. 2예에서는 농양천자를, 1예에서는 골생검을 초음파유도하에 시행하여 세균학적, 병리조직학적 검사를 위한 가검물을 얻었다. 결론적으로, 초음파검사로 골병변과 접한 농양을 관찰함으로서 골감염을 조기에 진단할 수 있을 뿐아니라 화농성과 결핵성의 감별진단에도 도움이 될 수 있고, 초음파유도하 농향흡인이나 골생검을 시행하면 원인균의 규명과 병리학적진단을 위한 가검물을 채취할 수도 있다.

절제된 정상위벽의 자기공명영상기법에 관한 연구:조직소견과의 비교

서보경,설혜영,이남준,차인호,정규병,김정혁,박철민,이지영,Seo, Bo-Gyeong,Seol, Hye-Yeong,Lee, Nam-Jun,Cha, In-Ho,Jeong, Gyu-Byeong,Kim, Jeong-Hyeok,Park, Cheol-Min,Lee, Ji-Yeong 대한영상의학회 2001 대한영상의학회지 Vol.45 No.5

목적:급속자기공명영상기법을 이용하여 절제된 정상위벽을 관찰하고,이를 조직소견과 비교 연구하여,위벽의 관찰을 위한 최적기법을 찾고자 하였다. 대상과 방법:25명 환자의 모두 41개 절제된 정상위조직을 수술후 수지(polyethylene)통에 넣고,생리식염수로 채워 자기공명영상을 시행하였다.T1강조FLASH,지방억제T1강조FLASH, T2강조TSE와 True-FISP 등 4가지 기법으로 위조직의 영상을 얻었다.자기공명영상에서는 위벽의 층수와 각층의 신호강도를 관찰하였고,이를 조직소견과 비교하였다.자기공명영상소견을 조직소견과 비교한 후 위벽 각층의 명확성과 각층간의 구분,및 전체 영상의 질에 대하여 비교하였다.4가지 기법 중 가장 좋은 방법은 3,가장 나쁜 방법은 0으로 하여 등급을 판정하였다. 결과:자기공명영상에서 위벽의 층수는 T1강조FLASH에서 2층이 41예 중 6예(14.6%),3층 31예(75.6%),및 4층 4예(9.8%)였고,지방억제T1강조FLASH에서 2층 6예(14.6%)와 3층 35예(85.4%),T2강조TSE에서 3층 24예(58.5%),4층 11예(26.8%),및 5층 6예(14.6%)였으며,True-FISP에서 1층 2예(4.9%),2층 8예(19.5%),3층 23예(56.0%),4층은 4예(9.8%), 및 5층 4예(9.8%)이었다.위벽의 신호강도는 T1강조FLASH와 지방억제T1강조FLASH에서 2층으로 보인 예는 위내강으로부터 고-중등도,3층인 경우는 고-저-고/중등도,4층인 예는 고-저-고-중등도신호강도였다.T2강조TSE에서는 3층으로 보인 예는 등도/고-저-중등도,4 층인 경우는 중등도-저-고-중등도/저,5층인 예는 저-고-저-고-저신호강도였다.자기공명 영상소견을 조직소견과 비교하였을 때 위벽이 3층으로 보인 경우 이것은 “점막층-점막하층-근층 ”에 해당하였다.관찰한 3가지 면 모두에서 T1강조FLASH,지방억제T1강조FLASH,T2강조TSE 기법이 True-FISP보다 통계적으로 유의하게 우수하였다(p=0.001).점막층의 명확성에 있어서 가장 우수한 기법은 T1강조FLASH와 지방억제T1강조FLASH이었고(p<0.05),점막하층의 명확성과 점막하층과 근층간의 구분은 T2강조TSE가 가장 우수하였다(p<0.05).전체적인 영상의 질은 T1강조FLASH와 T2강조TSE에서 가장 우수하였다(p<0.05). 결론:자기공명영상은 위벽의 각 층을 구별할 수 있는 우수한 검사로 조직소견과 높은 연관성을 보이며,전체 영상의 질,점막하층의 명확성 및 점막하층과 근층간의 구분이 T2강조TSE에서 가장 우수한다. Purpose: To evaluate normal human gastric wall layers in vitro using magnetic resonance*(MR) imaging, to correlate the results with the histologic findings, and to determine the optimal technique for evaluation of the gastric wall. Materials and Methods: Forty-one normal resected gastric specimens obtained from 25 patients were dissected and placed in a polyethylene tube filled with normal saline. MR imaging with four MR sequences, T1-weighted FLASH*(T1FLASH), fat-saturated T1-weighted FLASH, T2-weighted TSE*(T2TSE), and True-FISP, was performed. The number of gastric wall layers and signal intensity of each layer were determined, and after correlating MR images with the histologic findings, the conspicuity of each layer*(mucosa, submucosa, and muscle), the distinction between each layer, and overall image quality were assessed. results: The gastric wall was shown by TIFLASH to have two (n=6, 14-6%), three (n=31, 75.6%) and four layers (n=4, 9.8%); by fat-saturated TIFLASH to have two (n=6, 14.6%) and three (n=35, 85.4%) ; by T2TSE to have three (n=24, 58.5%), four (n=11, 26.8%), and five (n=6, 14.6%); and by True-FISP to have one (n=2, 4.9%), two (n=8, 19.5%), three (n=23, 56%), four (n=4, 9.8%), and five (n=4, 9.8%) . The signal intensity of each layer at T1FLASH and fat-saturated T1FLASH was high-intermediate from the lumen in two-layer cases, high-low-high/intermediate in three-layer cases, and high-low-high-intermediate in four-layer cases. The signal intensity of each layer at T2TSE was intermediate/high-low-intermediate in three-layer cases, intermediatelow-high-intermediate/low in four-layer cases, and low-high-low-high-low in five-layer cases. Three-layered gastric wall corresponded mostly to mucosa, submucosa, and muscle from the inner to outer layers, respectively. T1FLASH, fat-saturated T1FLASH, and T2TSE were superior to True-FISP in evaluating the gastric wall. T1FLASH and fat-saturated T1FLASH were the best sequences for demonstrating mucosa (p<0.05), and T2TSE was the best for submucosa and the distinction between this and muscle (p<0.05). Both T1FLASH and T2TSE provided the best overall image quality (p<0.05). Conclusion: In-vitro MR imaging is an excellent technique for the evaluation of layers of normal gastric wall. T2TSE is the sequence which best demonstrates the conspicuity of submucosa, the distinction between submucosa and muscle, and overall image quality.

高 에너지 放射線으로 單一照射한 家兎小腸의 病理組織學的 變化

崔日淳,薛惠榮,徐源赫 고려대학교 의과대학 1986 고려대 의대 잡지 Vol.23 No.1

When super-voltage cobalt 60 gamma ray treat many kinds of intra-abdominal tumors the small intestine is exposed to unwanted radiation effect and excessive amount of radiation dose is harmful for the small intestine. Author attempted the experimental study to search for maximum tolerable radiation dose of small intsetine. The pathological changes of small intestine of the rabbits following 1,500 rads, 2,500 rads and 3,500 rads single exposure of Cobalt 60 gamma ray have obtained with 80 experimental rabbits. The doses of 1,500 rads, 2,500 rads and 3,500 rads single exposures were equivalent of biologic effects of 4,500 rads in 4.5 weeks, 7,000 rads in 7 weeks and 9,000 rads in 9 weeks each other. Following 1,500 rads single exposure rabbits were terminated in 2 , 4 , 8 weeks intervals, 2,500 rads single exposure rabbits were terminated in 1, 2, 4 weeks intervals and 3,500 rads single exposure rabbits were terminated at two weeks period. And the small intestines were fixed to Formalin Solution immediately after dissection. The pathological changes were as follows: 1. Following 1,500 rads single exposure, 10%(3/30 ) of rabbits were dead by radiation and the small intestinal mucosa showed the necrosis of 100% in weeks subgroup and the inflammation of 73% and regeneration of 63% in 2.4% and 8 weeks subgroups. 2. Following 2,500 rads single exposure,57% (17/30) of rabbits were dead and the small intestinal mucosa showed the necrosis of 87%, inflammation of 89% and regeneration of 53% in 1 week, 2 weeks and 4 weeks subgroups. 3. Following 3,500 racs single exposure, 93%(14/15) of rabbits were dead and the small intestine showed necrosis of 100% and inflammation of 47% in 2 weeks subgroup. 4. 4 rabbits showed the metaplastic changes on small intestine in 1,500 rads and 2,500 rads single exposure groups. In conclusion, over 1,500 rads single exposure by using high energy radiation caused severe radiation effects and metaplastic changes on small intestines of rabbits.