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후두 편평상피암종의 림프절 피막외 침범에 대한 FDG PET/CT 영상의 유용성
주영훈(Young-Hoon Joo)유이령(Ie-Ryung Yoo),조광재(Kwang-Jae Cho),송지남(Jee-Nam Song),유동준(Dong-Joon Yoo),이호석(Ho-Suk Lee),김민식(Min-Sik Kim) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2
Backgrounds:To evaluated the use of FDG PET/CT for the identification of extracapsular spread(ECS) with histologic correlation in laryngeal cancer. Methods:We reviewed 79 medical records of patients who under-went of FDG PET/CT for laryngeal cancer before surgery. Results:ECS was present in 41.9%(18/43) dis-sected necks and in 34.5%(20/58) dissected cervical levels. There was a significant difference in the SUVmax between cervical lymph nodes with ECS and without ECS(6.39±4.53 vs. 1.19±1.64, p<0.001). The cut-off value for the SUVmax for differentiating with ECS from without ECS was 2.8 with the sensitivity of 85.7% and the specificity of 85.6%. Conclusion:The median SUVmax cut-off values of FDG PET/CT higher than 2.8 was associated with greater risk cervical lymph node metastasis with ECS in patients with laryngeal cancer.
Evaluation of Neoadjuvant Chemotherapy Effect in Osteosarcoma
주민욱,강용구,유이령,최우희,정양국,김동현,강진우,Joo, Min Wook,Kang, Yong-Koo,Yoo, Ie Ryung,Choi, Woo Hee,Chung, Yang-Guk,Kim, Dong-Hyun,Kang, Jin-Woo The Korean Musculoskeletal Tumor Society 2014 대한골관절종양학회지 Vol.20 No.2
목적: 골육종에 대한 술전 항암화학요법의 효과를 조기에 비침습적으로 평가하기 위해 다양한 영상 진단 기법들을 사용해 왔다. 저자들은 골육종에 대한 술전 항암화학요법의 효과를 예측하는 데 있어 단순 촬영 및 양전자 방출 단층 촬영과 같은 영상 검사들의 효용성을 평가하고 양성자 방출 단층 촬영에서 얻어진 값들을 해석하는 데 있어서의 통칙을 정해 보고자 하였다. 대상 및 방법: 2주기 술전 항암화학요법 후 외과적 절제를 시행한 18명의 골육종 환자들을 대상으로 하였다. 남자 13명, 여자 5명이었으며, 연령의 중위수는 19세였다. 술전 항암화학요법의 전후로 단순 촬영 및 양전자 방출 단층 촬영을 시행하였다. 절제된 종양에 대해 병리검사를 시행하여 조직학적 반응 등급을 확인하였다. 조직병리학적 괴사 정도와 방사선학적 소견, 술전 항암화학요법 후 최대 표준섭취계수(maximum standardized uptake value), 평균 표준섭취계수(average standardized uptake value), 대사종양용적(metabolic tumor volume) 및 해당 값들의 감소율에 대해 통계학적 분석을 시행하였다. 결과: 조직학적 평가 상, 8명의 환자에서 술전 항암화학요법에 대해 좋은 반응을 확인하였다. 최대 표준섭취계수 감소율의 중위수는 좋은 반응을 보인 군에서 74 (23-77) %였고, 나머지에서 42 (-32-76) %였다. 대사종양용적 감소율의 중위수는 좋은 반응을 보인 군에서 93.5 (62-99) %였고 나머지에서 46 (-81-100) %였다. 방사선학적 소견의 범주는 조직학적 반응에 따른 차이가 없었지만 (p=1.0), 최대 표준섭취계수의 감소율은 유의한 차이를 보였다(p=0.041). 대사종양용적의 감소율 차이는 통계학적 유의성에 근접하였다(p=0.071). 결론: 본 연구에서 방사선학적 소견의 범주는 골육종에 대한 술전 항암화학요법의 효과를 평가하는 데 있어 신뢰할 수 없었지만, 최대 표준섭취계수는 유용한 척도였다. 양전자 방출 단층 촬영에서 얻어지는 값들은 여러 요인에 의해 영향을 받으므로, 각 기관은 기왕의 연구들을 참고로 각자의 판단 기준을 마련하기 위해 노력해야만 한다. Purpose: Various diagnostic imaging modalities have been used to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma early and noninvasively. We evaluated the effectiveness of imaging studies of plain radiographs and positron-emission tomography/computed tomography (PET/CT) in predicting neoadjuvant chemotherapy effect for osteosarcoma and tried to establish a general principle in interpretation of PET/CT parameters. Materials and Methods: Eighteen patients who underwent two cycles of neoadjuvant chemotherapy and surgical excision for osteosarcoma were enrolled. There were 13 males and 5 females, with a median age of 19 (11-63) years. Fifteen patients of 18 had the American Joint Committe on Cancer (AJCC) stage IIB. They had plain radiographs and PET/CT before and after neoadjuvant chemotherapy. The resected tumor specimens were pathologically examined to determine histological response grade using a conventional mapping method. Statistical analysis was performed to evaluate the correlation between histopathological necrosis rate, and radiographic finding category, post-chemotherapy maximum standardized uptake value (SUVmax), average standardized uptake value and metabolic tumor volume (MTV) as well as reduction rates of them. Results: Eight patients were good responders to neoadjuvant chemotherapy based on histological evaluation. Median SUVmax reduction rate was 73 (23-77) % in good responders and 42 (-32-76) % in poor responders. Median MTV reduction rate was 93.5 (62-99) % in good responders and 46 (-81-100) % in poor responders. While radiographic finding category was not different according to histological response (p=1.0), SUVmax reduction rate was significantly different (p=0.041). Difference in MTV reduction rates approached statistical significance as well (p=0.071). Conclusion: While radiographic finding category was not reliable to assess neoadjuvant chemotherapy effect for osteosarcoma, reduction rate of SUVmax was a useful indicator in this study. As parameters of PET/CT can be influenced by various factors of settings, different centers have to make an effort to establish their own standard of judgement with reference of previous studies.
조송미,지원희,유이령,이아원,정양국,Cho, Song-Mee,Jee, Won-Hee,Yoo, Ie-Ryung,Lee, Ah-Won,Chung, Yang-Guk The Korean Musculoskeletal Tumor Society 2010 대한골관절종양학회지 Vol.16 No.1
Fibrous dysplasia is a common benign disorder of bone in which normal bone marrow is replaced with fibro-osseous tissue. As PET/CT is increasingly used for the staging of different malignant disease, incidentally found fibrous dysplasia with increased FDG uptake may mimic metastasis. We report on a 46-year-old woman with fibrous dysplasia who underwent PET/CT because of suspected recurrence of breast cancer and was misdiagnosed as a bony metastasis with a focal FDG uptake on left proximal femur. This lesion was interpreted as fibrous dysplasia based on MRI in addition to the plain radiographs. We conclude that MRI in addition to radiography may help to differentiate fibrous dysplasia mimicking metastasis on PET/CT in the patients with malignancy. 섬유형성이상은 골수가 섬유-골성 조직으로 치환되는 흔한 양성 골 질환이다. 암환자에서 병기의 결정과 추적 검사 시 암 전이의 발견에 PET/CT의 역할이 증가됨에 따라 우연히 발견된 FDG 섭취 증가를 보이는 섬유형성이상에서 암 전이와의 감별이 중요하다. PET/CT를 시행한 46세의 유방암 환자에서 좌측 대퇴골에 국소 FDG 섭취를 보여 암 전이로 의심되었으나 단순촬영과 자기공명 영상 소견에서 섬유형성이상으로 진단한 환자의 증례를 보고하고자 한다. 이 환자에서 단순활영과 자기공명영상 소견은 PET/CT에서 유방암 전이로 오인된 섬유형성이상의 감별에 도움이 되었다.
Tc-99m Pertechnetate / TI-201 감영 신티그라피에서 부갑상선 선종으로 오인된 흉선종 1 예
정용안(Yong An Chung),유이령(Ie Ryung Yoo),김성훈(Seong Jang Kim),정수교(Soo Kyo Chung),왕영필(Young Pil Wang),정지한(Ji Han Jung),이교영(Kyo Young Lee),김병기(Byung Kee Kim) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.4
A large superior mediastinal mass was found incidentally by ultrasonography in a 60-year-old man. There was an abnormal accumulation of Tl-201 in the lower pole of left thyroid gland, extending into left superior mediastinum on Tc-99m pertechnetate/Tl-201 subtraction scan. Laboratory findings relating thyroid and parathyroid were all within normal range. We considered the mass as a non-functioning parathyroid adenoma tentatively. However, subsequent surgery and pathologic examination revealed the mass to be a benign mixed thymoma. We report a case of patient with thymoma showing unusual Tc-99m pertechnetate/Tl-201 subtraction imaging and laboratory findings, and suggest to consider the possibility of other mediastinal tumors rather than parathyroid adenoma. (Korean J Nucl Med 2001;35:274-279)
구강 및 구인두 편평상피암종의 림프절 전이에 대한 PET-CT 영상의 유용성
주영훈(Young-Hoon Joo),선동일(Dong-Il Sun),박준욱(Jun-Ook Park),유이령(Ie-Ryung Yoo),김민식(Min-Sik Kim) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.1
Objectives :We evaluated the use of FDG PET/CT for the identification of cervical nodal metastases of SCC of the oral cavity and oropharynx with histological correlation. Material and Methods :We reviewed 46 medical records, from January 2004 to July 2007, of patients who underwent FDG PET/CT and CT/MRI for SCC of the oral cavity and oropharynx before surgery. We recorded the lymph node metastases according to the neck level affected and the system used for the imaging-based nodal classification. Results :The FDG PET/ CT had a sensitivity of 75.6% and a specificity of 96.7%;it had a higher sensitivity than the CT/MRI for identi-fication of cervical metastases on the side of the neck(26/28 vs. 20/28, p=0.031) and at each of the cervical levels(34/45 vs. 26/45, p=0.008). There was a significant difference in the SUV max between the benign and malignant cervical lymph nodes(3.31±3.23 vs. 4.22±2.57, p=0.028). The receiver-operating-characteristic (ROC) curve analysis for differentiating the benign from the malignant cervical lymph nodes, showed that the area under the curve(AUC) of the FDG PET/CT was 0.775. The cut-off value for the SUV max was 2.23 based on the ROC curve. There was a significant correlation between the SUV max and the size of the cervical lymph nodes(Spearman r=0.353, p=0.048). Conclusion :FDG PET/CT images were more accurate than the CT/MRI images. In addition, the SUV max cut-off values were important for evaluating cervical the cervical nodes in the patients with SCC of the oral cavity and oropharynx.