손목터널증후군의 고해상도 초음파소견

장혁원,이진희,이창수,이성문,우성구 대한초음파의학회 2002 ULTRASONOGRAPHY Vol.21 No.2

PURPOSE : To describe US findings of carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of US in CTS by measuring the cross-sectional area of the median nerve. MATERIALS and METHODS : Thirty one wrists from 21 patients with CTS diagnosed clinically and by electromyography and thirty two wrists from 16 normal control patients were included. The age of the patients with CTS ranged from 36 to 65 years (mean=51 years); the age of the normal control group, 31 to 62 years (mean=43 years). Axial images of the wrists at the levels of the radiocarpal joint (RCJ), mid-level of the lunate and the capitate in the neutral position were obtained. The cross sectional area (CSA) of the median nerve was calculated at three levels using a indirect method by employing a ellipse tool programmed built in sonographic machine. RESULTS : In patients with CTS, CSA measured at the radiocarpal joint, mid-level of the lunate and capitate were 12.35±3.90 mm2, 14.68±3.83 mm2 and 8.48±1.88 mm2, respectively. On the other hand, CSA of the control group, 8.44±1.41 mm2, 8.75±1.46 mm2, and 8.19±1.47 mm2, respectively. CSA at the radiocarpal joint and the mid lunate was bigger (or larger) in patients with CTS than in that of the controls with a statistical significance (p < 0.05) while CSA at the mid capitate was slightly bigger in patients with CTS than that of the controls but without a statistical significance. CSA of the median nerve over 12 mm2 at the mid lunate level was highly predictive of carpal tunnel syndrome (sensitivity=80.6%, specificity=93.8%, positive predictive value = 92.6%, negative predictive value=83.3%, and likelihood ratio = 13). CONCLUSION : High resolution US can be useful in diagnosis of CTS, and CSA of the median nerve over 12 mm2 at the mid lunate level is highly predictive of carpal tunnel syndrome. 목적 : 고해상도 초음파 검사로 정중신경 단면적을 측정하여 손목터널증후군의 진단적 가치를 알아보고자 한다. 대상 및 방법 : 임상 증상 및 근전도검사에서 손목터널증후군으로 진단된 환자 21명의 31예와 대조군으로 정상인 16명의 32예를 대상으로 하였다. 환자군의 평균연령은 51세였으며 여자 20명, 남자 1명이었다. 정상대조군의 평균연령은 43세였으며 남자 9명, 여자 7명이었다. 초음파 검사는 손바닥을 위로 한 상태에서 손목을 중립으로 위치하여 시행하였으며 요수근관 절 부위, 월상골 중간부위 및 유두골 중간부위 각각의 횡단면 영상에서 정중신경의 단면적을 구하였다. 결과 : 환자군과 대조군의 정중신경의 단면적은 각각 요수근관절 부위에서 12.35±3.90mm2, 8.44±1.41 mm2, 월상골 중간부위에서 14.68±3.83 mm2, 8.75±1.46 mm2, 유두골 중간부위에서 8.48±1.88 mm2, 8.19±1.47 mm2이었다. 요수근관절과 월상골 중간부위에서의 정중신경 단면적은 환자군에서 대조군보다 유의하게 증가되었다(p<0.05). 유두골 중간부위에서의 정중신경 단면적은 환자군에서 대조군보다 증가되었으나 통계적으로 유의성은 없었다. 월상골 중간부위에서 손목터널증후군 진단에 기준이 되는 정중신경 단면적을 12 mm2로 하였을 때 민감도 80.6%, 특이도 93.8%, 양성예측도 92.6%, 음성예측도 83.3%, 우도비 13이었다. 결론 : 고해상도 초음파 검사는 손목터널증후군의 진단에 유용한 검사이며 월상골 중간부위에서 정중신경 단면적이 12 mm2를 초과하면 손목터널증후군의 진단에 도움을 줄수 있다.

산전 초음파로 진단된 무심장 기형 쌍태아 임신: 2예 보고

장혁원,이진희,김정식,조재호,김종인 대한초음파의학회 2002 ULTRASONOGRAPHY Vol.21 No.2

Acardiac twin is characterized by the absence or rudimentary development of the fetal heart and associated various anomalies, especially anencephalus and severe subcutaneous edema or cystic hygroma. On doppler US, reversed flow through the umbilical cord of the acardiac fetus is charactersitic. We experienced two cases of acardiac twin gestation diagnosed by antenatal ultrasonography and present these cases with a brief review of the literatures. 무심장 기형은 초음파검사에서 심장의 완전한 결손이나 흔적적인 발육과 함께 기형태아의 몸의 일부분의 결손이나 흔적적인 발육, 피부와 피하조직의 심한 부종등의 소견을 보인다. 도플러 초음파검사에서 제대동맥의 혈류가 역방향으로 흐르는 것이 무심장 기형태아의 특징적 소견이다. 저자들은 산전 초음파로 진단된, 무심장 기형 쌍태아 임신 2예를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다.

MRI Imaging of Simultaneously Developed Endogenous Endophthalmitis and Brain Abscesses

김영환,장혁원,김미정,정혜라,조지형 대한자기공명의과학회 2013 Investigative Magnetic Resonance Imaging Vol.17 No.1

Endogenous endophthalmitis is rare and refers to an intraocular inflammatory process that may result from exogenous or endogenous causes. Magnetic resonance imaging (MRI) is useful for diagnosing endophthalmitis, and valuable to reach the diagnosis of brain abscess. We report here the MR findings of simultaneously developed endogenous endophthalmitis and brain abscesses.

자기공명혈관조영술로 진단된 제2형 전환추동맥 (Proatlantal Artery): 증례 보고

전성우,장혁원,김미정,조지형 대한자기공명의과학회 2013 Investigative Magnetic Resonance Imaging Vol.17 No.1

전환추동맥은 드물게 보고된 태생기 경-기저동맥문합 잔류동맥의 하나이다. 태생 3주경에 발생하는 경-기저동맥문합은 삼차동맥, 귀동맥, 설하동맥, 그리고 전환추동맥으로 이루어지며, 정상인에서는 태생 6주경 전환추동맥을 마지막으로 모두 퇴화된다. 일반적으로 전환추동맥은 주로 내경동맥에서 기원하며 경추 가로돌기구멍을 통과하지 않는 제1형과, 외경동맥에서기원하여 첫째 경추 가로돌기구멍을 통과하는 제2형으로 나뉘며, 임상적인 증상을 일으키는 경우는 드물다. 그러나 비교적잘 동반되는 척추동맥의 무형성을 포함한 두개강내 동맥기형이 있을 수 있으며, 이는 경동맥 내막 절제술 및 외경동맥 색전술등의 시술시 의의가 있어 심도 있는 이해가 필요하다. 이에 저자들은 자기공명혈관조영술로 진단된 제2형 전환추동맥 증례보고와 문헌고찰을 하고자 한다.

전두사골동의 골종과 동반된 기뇌증과 공뇌증: 증례 보고

박준범,장혁원 대한영상의학회 2008 대한영상의학회지 Vol.59 No.5

골종은 흔한 양성 질환으로 부비동에서 잘 생기며 보통은 증상이 없다. 하지만, 전두동 또는 사골동의 골종으로 인한 기뇌증은 매우 드물지만 심각한 부작용을 가져올 수도 있다. 이에 저자들은 기뇌증이 생긴 환자에게서 동반된 전두사골동 골종과 공뇌증을 경험하여 이를 보고하고 문헌고찰을 한다.

Deep Sylvian Meningioma in a 43-Year-Old Man:A Case Report

김진영,장혁원,이은주,정혜라,김일만,김상표 대한자기공명의과학회 2013 Investigative Magnetic Resonance Imaging Vol.17 No.4

Deep sylvian meningioma is a rare form of meningiomas. So far, only 4 cases including the present one have been reported in South Korea. A 43-year-old man without any previous medical history presented to our hospital with seizure. There was a rim enhancing mass in the right deep sylvian fissure without dural attachment on magnetic resonance images. Surgical resection of the mass revealed the lesion to be a meningioma in this patient.

안구 침범을 동반한 두경부 방선균증

이태영,이은주,장혁원,정혜라,김일만,이형,김상표,이상권 대한자기공명의과학회 2014 Investigative Magnetic Resonance Imaging Vol.18 No.1

방선균증은 그람 양성 혐기성 균인 악티노미세스과 (Actinomycetaceae)로 인하여 발생하며, 안구 감염의 원인으로서의 방선균증은 드물다고 알려져 있다. 저자들은 60세 남자에게서 발견된 안구 봉와직염을 포함한 경부안면형과 중추신경계형방선균증의 자기공명영상 소견을 보고하고자 한다. T1 강조 안구 자기공명영상에서 안구를 비롯한 두경부에 다수의 비정상적 조영증강 병변이 보였으며, 일부에서는 농양들으로 생각되는 저 신호강도들을 포함하고 있었다. 병변은 절개 생검을 통하여 방선균증으로 진단되었고, 이후 페니실린계 항생제를 사용하여 완치되었다.

잔류 원시 후각동맥의 자기공명 및 전산화단층촬영 혈관조영술 소견: 한국인에서의 빈도와 동맥류와의 연관성

권보라,여수현,장혁원,김미정,김일만,김미경,조호찬,김혜순,이성문 대한영상의학회 2012 대한영상의학회지 Vol.66 No.6

Purpose: Japanese data indicates an incidence of persistent primitive olfactory artery (PPOA) of 0.14%. We studied the incidence of PPOA and associated cerebral vascular variation or anomalies in Korea. Materials and Methods: We retrospectively reviewed cranial magnetic resonance angiography (MRA) and computed tomography angiography (CTA) images of a total of 9841 patients of our institution. The diagnostic criterion of PPOA is extreme anterioinferior course of the proximal anterior cerebral artery, with a hairpin turn of the lateral projection. Results: We found 29 cases (0.29%) with PPOA. The PPOA location was on the left in 19 cases, bilateral in 3 cases, and on the right in 7 cases. An aneurysm was found at the hairpin turn in 2 patients. There were aneurysms in other sites in 3 cases. There were hypoplasia of anterior cerebral artery in 3 cases, and fenestration of intracranial artery in 1 case. Conclusion: In Korean populations, the incidence of PPOA found in MRA and CTA was twice as high as that shown in the previous Japanese data. Within Korea, left side laterality is more common than right side or bilalterality. Aneurysmal dilatations at the hairpin turning point and aneurysms at other sites were found, and other vascular variations were observed in several cases.

결핵수막염에서 발병한 모야모야증후군

나건엽,김근태,장혁원,이형,이현아 대한신경과학회 2011 대한신경과학회지 Vol.29 No.1

While it is generally considered that tuberculous meningitis (TBM) causes various vascular complications, there have been few reports of moyamoya syndrome following TBM. A 23-year-old female was diagnosed as TBM. Preliminary brain MRA yielded normal findings. Follow-up MRA and cerebral angiography conducted 1.5 years later yielded findings that were consistent with moyamoya disease. They showed no interval change after 2 years, and the patient had no neurological deficits. This patient with TBM subsequently developed moyamoya syndrome during the course of antituberculosis medication.

내경동맥 근위부의 협착 및 폐쇄에 의한급성 뇌경색 환자에서 응급 경동맥 스텐트술

배기윤,홍정호,손성일,장혁원,손철호 대한신경과학회 2008 대한신경과학회지 Vol.26 No.3

Background: The aim of this study was to investigate the feasibility and efficacy of emergent carotid artery stenting (CAS) for occlusion or high-grade stenosis of the internal carotid artery (ICA) in patients with acute ischemic stroke. Methods: From November 2004 to May 2007, 17 patients admitted to the hospital within 12 hours of symptom onset with occlusion or a high-grade stenosis of the proximal ICA underwent emergent CAS. We analyzed risk factors, imaging findings, functional outcome scales, and peri-procedural complication. The outcome was measured by the modified Rankin scale (mRS) 3 months later and classified into good (mRS score of 0 to 2) or poor (mRS score of 3 to 6). Results: All patients were recanalized successfully. The median National Institutes of Health Stroke Scale (NIHSS) score was 12.6 (range 4 to 24) just before the emergent CAS, which decreased to 9.4 and 8.2 at 1 day and 7 days after the stenting. Three months later, 12 patients showed good outcome while three had poor outcome and two of them died. Two patients (11.8%) exhibited symptomatic hemorrhagic transformation following the emergent CAS. Smoking status, and initial and immediate post-procedural NIHSS scores were associated with the outcome. Conclusions: Emergent CAS is a feasible and effective method in acute treatment of selected stroke patients with steno-occlusion of the proximal ICA. Background: The aim of this study was to investigate the feasibility and efficacy of emergent carotid artery stenting (CAS) for occlusion or high-grade stenosis of the internal carotid artery (ICA) in patients with acute ischemic stroke. Methods: From November 2004 to May 2007, 17 patients admitted to the hospital within 12 hours of symptom onset with occlusion or a high-grade stenosis of the proximal ICA underwent emergent CAS. We analyzed risk factors, imaging findings, functional outcome scales, and peri-procedural complication. The outcome was measured by the modified Rankin scale (mRS) 3 months later and classified into good (mRS score of 0 to 2) or poor (mRS score of 3 to 6). Results: All patients were recanalized successfully. The median National Institutes of Health Stroke Scale (NIHSS) score was 12.6 (range 4 to 24) just before the emergent CAS, which decreased to 9.4 and 8.2 at 1 day and 7 days after the stenting. Three months later, 12 patients showed good outcome while three had poor outcome and two of them died. Two patients (11.8%) exhibited symptomatic hemorrhagic transformation following the emergent CAS. Smoking status, and initial and immediate post-procedural NIHSS scores were associated with the outcome. Conclusions: Emergent CAS is a feasible and effective method in acute treatment of selected stroke patients with steno-occlusion of the proximal ICA.