과혈관성 종양의 동맥색전술 : Transcatheter Embolization of Hypervascular Tumor

은충기,전제량,정덕환 인제대학교 1986 仁濟醫學 Vol.7 No.1

Therapeutic transcatheter arterial embolization of neoplasms has become an integral part of interventional radiology recently. Transcatheter embolization with Ivalon, Gelfoam particles and absolute ethanol was applied in 6 cases with hypernephroma (2 cases), hepatocellular carcinoma (2 cases), liver metastasis (1 case) and nasopharyngeal angiofibroma (1 case). The results were as follows. 1.Devascularization of hypernephroma with absolute ethanol was complete and patients are living for about 3 years and 4 months. 2.Almost total devascularization of hepatocellular carcinoma and liver metastasis with Gelfoam and Ivalon was possible. 3.Nasopharyngeal angiofibroma was completely removed by operation after transcatheter embolization with Ivalon particles. 4.Complications after embolization were fever, nausea, vomiting and pain, but they were subsided within 7 days except a case of hepatoma.

요추간판 탈출증의 진단에 있어서 전산화단층촬영술과 척수조영술의 비교

은충기 인제대학교 1988 仁濟醫學 Vol.9 No.3

요추부 동통을 주소로 내원한 환자들 중 CT와 척수조영술을 동시에 시행하고 수술로써 요추간판돌출을 확인한 총 42예의 환자를 대상으로 CT와 척수조영술의 진단적 가치를 비교 분석하여 문헌 고찰과 함께 보고하는 바이다. A retrospective study was done to compare computed tomography with myelography in the diagnosis of herniated lumbar disc. 42 patients were surgically confirmed as disc protrusion in 47 lesions and normal or no disc lesion in 5 cases, and they were studied who had both myelography and CT or CT myelography in Pusan Paik hospital for recent 3years. Each examination was interpreted separately by author who has no information for the result of any radiologic studies and patients clinical findings. The results were as follows. 1.In spinal exploration of 52 levels of 42 patients, 46 CT and 41 myelographic diagnoses agreed with the operative diagnosis at that level. Among 47 protruded discs of 42 patients, there were 45 true positive & 2 false negative CT diagnoses, and 40 true positive & 7 false negative myelographic diagnoses. There were 1 true negative & 4 false positive CT & myelographic diagnoses respectively. 2.In this study, CT demonstrated herniated lumber discs and some other pathology more accurately than myelography. So, CT should be serious consideration as the primary radiologic examination in the diagnosis of herniated lumbar disc, rather than myelography.

시신경염의 진단에 있어 지방과 액체를 동시에 억제한 SPIR-FLAIR 영상의 유용성: 지방억제 SPIR 혹은 STIR 영상과의 비교

은충기,한상석,Eun, Chung-Gi,Han, Sang-Seok 대한영상의학회 2001 대한영상의학회지 Vol.45 No.6

목적:시신경염(optic neuritis)의 진단시 유용한 소견 중 하나인 시신경에서의 고신호강도의 유무를 판정함에 있어서,지방억제 영상인 SPIR(selective partial inversion recovery)혹은 STIR(short inversion time inversion recovery)과 비교하여 지방과 액체를 동시에 억제한 SPIR-FLAIR(selective partial inversion recovery-fluid attenuated inversion recovery)영 상의 유용성을 알아보고자 하였다. 대상과 방법:시력 저하를 주소로 내원한 환자 중 임상증상, 시력 및 시야 검사, 시력유발전위치를 시행하여 임상적으로 시신경염으로 진단된 14명 환자(양측성 2명, 편측성 12명)의 16예의 병변을 대상으로 하였고 남녀비는 7:7이었으며 19-75세(평균연령:40세)의 연령분포를 보였다. 자기공명영상은 증상 발현 후 2-14일이내에 시행하였으며, 1.5T 자기공명영상기기를 이용하여 SPIR-FLAIR기법은 14명의 모든 환자에서, 지방억제 영상 중 12명은 SPIR기법으로, 나머지 2명은 STIR기법을 이용해 영상을 얻었다. 시신경을 중심으로 시신경의 종축에 수직이되도록 관상(coronal)영상을 얻었다. 영상의 비교 분석을 위해 두 명의 신경방사선과 전공 전문의가 무작위로 섞인 대상군에서 임상 정보 없이 육안적인 방법만으로 시신경에서의 고신호강도 유무를 판정하였고, 이 때 두 영상 방법에서 판독자간의 판정의 일치율과 판정시 더 유용하였던 영상 방법을 조사하였다. 시신경에서의 고신호강도의 판정 기준은 반대쪽 시신경이나 대뇌 백질의 신호 강도보다 유의하게 증가된 경우로 하였다. 결과:시신경염 환자의 16예의 병변 중 시신경에서 고신호강도 판정율은 지방과 액체를 동시에 억제한 SPIR-FLAIR 영상에서는 평균 90%,지방억제 SPIR 혹은 STIR 영상에서는 평균 59%였다. SPIR-FLAIR 영상에서는 시신경이 정상으로 판정되었으나 지방억제 SPIR 혹은 STIR 영상에서 고신호 강도를 보였던 경우는 한 예도 없었다. 판독자간의 판정의 일치율은 SPIR-FLAIR 영상과 지방억제 SPIR 혹은 STIR 영상에서 각각 94%였다. 그리고 진단시 지방과 액체를 동시에 억제한 SPIR-FLAIR 영상이 더 유용했다고 응답한 경우는 판독자별로 각 각 81%와 75%였다. 결론:시신경염 환자의 시신경에서 관찰되는 고신호강도의 육안적 판정율은 지방과 액체를 동시에 억제한 SPIR-FLAIR 영상이 지방억제 SPIR 혹은 STIR 영상보다 매우 높았다. 따라서 앞으로 시신경염의 자기공명영상진단에 지방과 액체를 동시에 억제한 SPIR-FLAIR 영상이 지방억제 SPIR 혹은 STIR 영상보다 유용한 검사법으로 생각한다. PURPOSE: To compare the usefulness of combined fat- and fluid-suppressed selective partial inversion recovery-fluid attenuated inversion recovery(SPIR-FLAIR) images in the detection of high signal intensity of the optic nerve in optic neuritis with that of fat-suppressed selective partial inversion recovery(SPIR) or short inversion time inversion recovery(STIR) images. MATERIALS AND METHODS: Two radiologists independently analyzed randomly mixed MR images of 16 lesions in 14 patients (M:F=7:7; mean age, 40years) in whom optic neuritis had been clinically diagnosed. All subjects underwent both SPIR-FLAIR and fat-suppressed SPIR or STIR imaging, in a blind fashion. In order to evaluate the optic nerve, coronal images perpendicular to its long axis were obtained. The detection rate of high signal intensity of the optic nerve, the radiologists' preferred imaging sequences, and intersubject consistency of detection were evaluated. 'High signal intensity' was defined as the subjective visual evaluation of increased signal intensity compared with that of the contralateral optic nerve or that of white matter. RESULTS: The mean detection rate of high signal intensity of the optic nerve was 90% for combined fat- and fluid-suppressed SPIR-FLAIR images, and 59% for fat-suppressed SPIR or STIR images. In all cases in which the signal intensity observed on SPIR-FLAIR images was normal, that on fat-suppressed SPIR or STIR images was also normal. The radiologists preferred the contrast properties of SPIR-FLAIR to those of fat-suppressed SPIR or STIR images. CONCLUSION: In the diagnosis of optic neuritis using MRI, combined fat- and fluid-suppressed SPIR-FLAIR images were more useful for the detection of high signal intensity of the optic nerve than fat-suppressed SPIR or STIR images. For the evaluation of optic neuritis, combined fat- and fluid-suppressed SPIR-FLAIR imaging is superior to fat-suppressed SPIR or STIR imaging.

간세포암의 전산화단층촬영 소견

은충기 대한영상의학회 1982 대한영상의학회지 Vol.18 No.3

It is well known that CT is very useful in the evaluation of hepatocellular carcinoma. The computed tomographic findings of 56 patients diagnosed as hepatocellular carcinoma were reviewed and analyzed. The results were as follows: 1. The male to female ratio was 3:1 and the age ranged from 31 to 73 years with average age of 54 years. 2. Alpha-fetoprotein was positive in 19 out of 38 cases (50%). HBsAg was positive in 8 out of 33 cases (24%). 3. All lesions were seen as areas of low density except 1 case (0%) of isodensity, and 40% cases (72%) appeared to be solitary while 15 (26%) were multifocal. The low density was homogenous in 13 cases (24%) and inhomogenous I 42 cases (76%), and 18 cases out of 42 cases of inhomogenous low density showed peripheral and/or central nodular enhancement. The additional findings were contour change in 37 cases (66%), metastasis in 35 cases (63%), splenomegaly in 23 cases (42%) and ascites in 22 cases (39%). 4. In postcontrast scans, 41 cases (80%) out of 51 cases showed the change density after contrast infusion. The presence and extent of tumors were better seen after contrast infusion in 30 cases (59%), better seen before contrast infusion in 11 cases (21%) and no significant difference before and after contrast infusion in 10 cases (20%). 5. The sites of involved lobe were right lobe in 38 cases (68%), left lobe in 5 cases (9%) and both lobes in 13 cases (23%). 6. 35 cases (63%) showed evidence of metastasis to regional lymph nodes, organ or tissues.

척추외상의 X-선학적 고찰

은충기 대한영상의학회 1978 대한영상의학회지 Vol.14 No.2

A statistical analysis was made in 115 cases of spinal injury with roentgenological evidences. The following results were obtained: 1. The males were affected far more frequently than the females with the ratio of 4 to 1. The spine injures occured in the third, fourth and fifth decades of life in 61.8% of the patients. 2. The most common cause of the spinal injury in this series was known to be fallingdown (40.9%), and the traffic accident was at the next in order(34.8%). 3. The spinal injuries affecting the lumbar and thoracolumbar regions were 88.4% in the all cases of falling-down and 72.5% in automobile accident. 4. The first lumbar vertebra was most commonly involved(21.8%) and then L2(18.1%) and T12(15.0%). 5. The majority of the spine injury was vertebral body fracture(78.8%), and the next was fracture of the tranverse process(9.5%). 6. The fracture involving a single vertebra was seen in 81.2%, and the most common injury in association with spinal injury was the multip e rib fractures.

한국인 성인의 정상위크기, 요추와의 관계 및 유동성에 관한 방사선학적 고찰

은충기 대한영상의학회 1977 대한영상의학회지 Vol.13 No.1

The kidney size and its movability on the change of position from supine to erect by radiographic measurement provide an important value in the diagnosis and treatment of the renal disease. The lengh of the kidney, the ratio between the kidney length and the total height of the upper three lumbar vertebrae including intervertebral disc, the movable range of kidney in change of position from recumbent to erect and the distance from the left hilum to the right hilum were measured on intravenous pyelograms of 87 males and 97 females of the age of 20 to 59 years. The following results were obtained: 1. The radiographic measurement of kidney size and its movable range: {{{{sex }}{{age }}{{right kidney }}{{left kidney }}{{hilum(cm) }}{{length(cm) }}{{M(cm) }}{{K(ratio) }}{{length(cm) }}{{M(cm) }}{{K(ratio) }}{{male }}{{20-59 }}{{12.4$\pm$0.76 }}{{2.8$\pm$1.57 }}{{1.08$\pm$0.07 }}{{12.7$\pm$0.84 }}{{2.7$\pm$1.46 }}{{1.12$\pm$0.08 }}{{1.3$\pm$1.37 }}{{female }}{{20-59 }}{{12.0$\pm$0.98 }}{{3.5$\pm$1.52 }}{{1.13$\pm$1.10 }}{{12.4$\pm$0.97 }}{{3.0$\pm$1.45 }}{{1.16$\pm$0.10 }}{{1.1$\pm$1.24 }} }} (M: The mean of the movable range of kidney in change of position from supine to erect) (K: The ratio between the length of kidney and the total height of the upper three lumbar vertebrae including disc) 2. The size of kidney in male and the right kidney was smaller than in female and the left one, and mean difference was 0.3-0.4 cm. But the right kidney was larger in 25% of the cases than the left one. 3. The length of kidney was larger in 90% of the cases than the total height of the upper three lumbar vertebrae including disc. 4. The motion range of kidney in the change of position from supine to erect was 0-8.2 cm and the moving distance of the kidney in the right side and female was a little greater than that in the left kidney and male. 5. In 3% of the cases the kidney moved more than 6 cm in change of position from supine to erect. 6. The right hilum was usually lower in position than the left one. However, in 24 cases (13%) the right hilum was observed to be higher than the l ft one.

교질형 방사선금을 이용한 간주사의 통계학적 관찰

은충기 대한영상의학회 1976 대한영상의학회지 Vol.12 No.2

The liver scintigrams with colloidal radiogold were statistically observed in 184 cases which were clinically and pathologically confirmed to be liver cirrhosis(85), hepatoma(47), liver abscess(15), hepatitis(15), metastatic carcinoma(6) and other liver diseases(16) at Sacret Heart Hospital. The obtained results were as follows: 1. Enlargement of the liver was commonly present in the diseased liver, particularly the cases with space occupying lesion. The diminution in size of the right lobe of the liver was most commonly seen in the liver cirrhosis. 2. Irregular distribution of the radioactivity,“mottling”pattern was seen in the majority of liver cirrhosis (82%), and other diseases also showed high appearing percentage of“mottling”(20-55%). The border of scan image was irregular in about 77% of liver cirrhosis and hepatoma, but smooth in 80% of liver abscess. 3. The visualization of the spleen by the uptake of radioisotope was commonly noticeable in all patients with liver diseases, particularly in liver cirrhosis (85%). The frequency of spleen visualization was seemed to be influenced by the extent of involved parenchyme of the liver. 4. The margin of“cold area”was well demarcated in liver abscess (67%) and hepatoma (21%). The shape of“cold area”was spherical or hemispherical in liver abscess (74%) and amorphous in hepatoma (57%). 5. The definite findings of the specific liver disease were not demonstrated in this study, however, in many cases of liver cirrhosis there could be noted the shrinkage of the right lobe of the liver, irregular border of scan image, the nonuniform distribution of radioactivity in the liver and the increased uptake in the spleen and bone marrow.

Galen 정맥기형

은충기 대한영상의학회 1986 대한영상의학회지 Vol.22 No.2

The vein of Galen malformation is a rare midline intracranial arteriovenous malformation. The majority of the malformations were seen in neonate, infancy and childhood, and the clinical symptoms and prognosis depended on age of presentation. The authors report a case of the vein of Galen malformation in 17 month-old female with hydrocephalus, which is confirmed by computed tomography and digitla subtraction angiogrpahy.

Metronidazole에 의한 뇌병증의 자기공명영상소견 1예 보고

은충기,손석현,김성은,김응규 인제대학교 1999 仁濟醫學 Vol.20 No.1

Metronidazole은 아메바병 등과 무산소성 염증을 치료하기 위하여 사용되는 약물이나 드물게 그 부작용으로 신경학적 이상을 초래할 수 있다. 저자들은 metronidazole의 부작용에 의한 뇌병증과 말초신경병증를 야기한 증례를 경험하여 자기공명영상소견및 문헌고찰과 함께 보고한다. 병변은 T2 강조영상 및 액체감쇠역전회복 영상에서 소뇌의 백질에 부종이나 종괴 효과를 동반하지 않는 양측성, 대칭성 병변을 보였고 약제 투여의 중단으로 임상증상과 병변은 호전되었다. Metronidazole is used for treatment of amebiasis, anaerobic infection and many other illness, but it produces a number of neurologic side effects. We report a case of metronidazole induced encephalopathy and peripheral neuropathy with MRI findings. Both T2-weighted and FLAIR images revealed bilateral and symmetrical lesions in the cerebellar white matter without surrounding edema and mass effect. With discontinuity of metronidazole, the lesions on MRI and clinical symptorms were completely improved.

라텍스 분리풍선에 의한 동맥색전술의 동물 실험

은충기,전제량,윤유진,김창수,안상원,정덕환 인제대학교 1987 仁濟醫學 Vol.8 No.2

외상성 경동맥해면동루는 분리풍선 카테타를 사용하여 누공을 폐색시키는 것이 최선의 치료 방법으로 알려져 있으나 조작이 용이하지 않고 고도의 기술이 필요한 것으로 알려져 있다. 저자들은 6마리의 가토를 대상으로 분리풍선 카테타의 조작 방법을 익히고 경동맥에 풍선을 분리시키는 실험을 하여 그 효과를 관찰하였다. The treatment of choice of the carotid-cavernous fistula is the occlusion of fistula by detachable balloons. We have experienced this sophisticated technique to 6 rabbits.