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1
Assessment of Carotid Diffusion-Weighted Imaging for Detection of Lipid-Rich Necrotic Core in Symptomatic Carotid Atheroma

이강지,곽효성,정경호,황승배,송지수 대한영상의학회 2016 대한영상의학회지 Vol.74 No.3
Purpose: To evaluate the diagnostic usefulness of diffusion-weighted MR imaging (DWI) compared with contrast-enhanced MR imaging for the detection of the lipid-rich necrotic core (LRNC) of symptomatic carotid atherosclerotic plaques. Materials and Methods: Twenty-five patients (median age: 66 years; range: 45–78 years) with moderate-to-severe symptomatic carotid stenosis confirmed with contrast-enhanced carotid MR angiography who underwent carotid plaque MR imaging were retrospectively reviewed. An echo-planner DWI with b0, b200, b400, b800, and b1000 was performed along with carotid plaque MR imaging. Plaque visualization on DWI was analyzed by 2 reviewers on consensus. The contrast-to-noise ratio between the lumen and plaque was analyzed between variable b-values. Results: Carotid atherosclerotic plaques were identified on carotid DWI in 8 patients. Confirmed carotid atherosclerotic plaques were not identified on carotid DWI in 16 patients. The DWI-identified group had plaques with significantly greater maximal wall thickness and longitudinal length, as compared with the non-identified group. DWI with b200 had a higher contrast-to-noise ratio between the lumen and LRNC (p < 0.001). The mean apparent diffusion coefficient value from DWI with b200 for the LRNC was 0.51 ± 1.55 × 10-3 mm2/s. Conclusion: There was less frequent identification of carotid atherosclerotic plaques with carotid DWI, as compared with contrast-enhanced MR imaging. This study suggested that carotid DWI cannot replace contrast-enhanced MR imaging for the detection of carotid plaques, including LRNC.
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경피적 흉부 생검시 투시 조영 유도하 생검에서 Cone-Beam CT 유도하생검으로 전환되는 데 영향을 미치는 요인

이강지,한영민,진공용,송지수 대한영상의학회 2015 대한영상의학회지 Vol.73 No.4
Purpose: To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. Materials and Methods: From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Results: Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in CT attenuation value. Conclusion: Low CT attenuation value and small short-axis diameter of the solid pulmonary lesion affect conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. 목적: 경피적 흉부 생검을 시행할 때, 투시 조영 유도하 생검에서 콘빔 CT 유도하 생검으로 시술 방법을 전환하는 데 영향을 미치는 요인을 알아보고자 하였다. 대상과 방법: 본 연구는 후향적으로 진행되었으며, 2011년 1월부터 2012년 12월까지 콘빔 CT를 이용한 경피적 흉부 생검을 시행 받은 환자 38명과 투시 조영 유도하 경피적 흉부 생검을 시행 받은 환자 중에서 콘빔 CT 유도하 경피적 흉부 생검군과 비슷한 연령과 성별, 폐 병변 위치를 보이는 76명의 환자를 대상으로 하였다. 투시 조영 유도하 흉부 생검에서 콘빔 CT를 이용한 흉부 생검으로의 전환에 영향을 미치는 예측 인자로서 고형 폐 병변의 장경, 단경, 전후 길이, 그리고 CT 감쇠값을 Pearson χ2 test와 Fisher exact test 및 독립 표본 t test를 이용하여 분석하였다. 또한 receiver operating charac-teristic (이하 ROC) curve 분석을 통해 콘빔 CT로의 전환을 결정하는 예측값을 찾고자 하였다. 결과: 투시 조영 유도하 경피적 흉부 생검을 시행 받은 환자들의 폐 병변의 평균 단경은 2.70 ± 1.57 cm, 평균 장경은 3.40 ± 1.92 cm, 평균 전후 길이는 3.06 ± 1.81 cm였으며, 평균 CT 감쇠값은 35.67 ± 15.70 Hounsfield unit (이하 HU)이었다. 콘빔 CT 유도하 경피적 흉부 생검으로 전환된 환자들의 폐 병변의 평균 단경은 1.60 ± 1.30 cm, 평균 장경은 2.20 ± 1.45 cm, 평균 전후 길이는 1.91 ± 1.99 cm였으며, 평균 CT 감쇠값은 18.32 ± 23.11 HU였다. 이러한 두 군 간에 고형 폐 병변의 단경과 장경, 전후 길이, 그리고 CT 감쇠값은 통계학적으로 유의한 차이를 보였다(각각 p = 0.001, p <0.001, p = 0.003, p < 0.001). CT 감쇠값과 단경의 교차비는 각각 0.952, 0.618로 나타났다. ROC curve에서 전환에 기준이 되는 적절한 단경은 1.65 cm(민감도 68.4%, 특이도 71.1%)였으며, CT 감쇠값은 29.5(민감도 65.8%, 특이도 65.8%)였다. 결론: 고형 폐 병변의 CT 감쇠값과 단경이 작을수록 콘빔 CT 유도하 생검으로의 전환이 더 잘 일어난다.
3
Percutaneous Transabdominal Metallic Stent Placement for Palliation of Afferent Loop Syndrome: A Case Report

김건영,한영민,정은하,진공용,채금주,이강지 대한영상의학회 2019 대한영상의학회지 Vol.80 No.2
- 복사/대출신청
The authors report a successful outcome after percutaneous transabdominal placement of a self-expandable metallic stent in a patient who had afferent loop syndrome caused by recurrent common bile duct adenocarcinoma. Enhanced abdominal CT showed marked dilation of the afferent loop adjacent to the anterior peritoneum, multiple hepatic metastases and lymph node metastasis around the choledochojejunal anastomosis site without marked dilation of intrahepatic bile ducts. Percutaneous drainage catheter was successfully placed to the dilated afferent loop just below the abdominal wall. Subsequent successful palliation of the afferent loop obstruction was achieved by placing a self-expandable metallic stent via the transabdominal route with the aid of cone-beam CT.

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