Tuberculosis and Respiratory Diseases : Percutaneous Radiofrequency Ablation For Atypical Carcinoid tumor: A Preliminary Report

진공용,이정민,이양근,이용철 대한결핵 및 호흡기학회 2001 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.93 No.-

15mm 이하의 단일성 폐결절에 대한 전산화단층촬영 유도하 자동 소총 생검의 유용성

진공용,임영수 대한영상의학회 2004 대한영상의학회지 Vol.50 No.4

VX2를 폐에 이식한 가토모델에서의 고주파 소작술: 완전 소작과 불완전 소작의 전산화 단층 촬영 소견에 대한 평가

진공용,한영민,임영수,장규윤,이상용,정경호 대한영상의학회 2004 대한영상의학회지 Vol.50 No.5

Purpose: To evaluate the radiologic findings for complete and partial ablation after percutaneous CT-guided transthoracic radiofrequency ablation (RFA) of lung VX2 tumor implanted in rabbits. Materials and Methods: Thirteen rabbits with successfully implanted lung VX2 were used. Three rabbits as controls did not receive RFA while the other ten rabbits underwent RFA; 5 complete and 5 partial. RFA was performed using an internally cooled, 17-gauge electrode (Radionics, Burlington, MA) with a 1-cm active tip under CT guidance. Postprocedural CT was performed within 3 days, and we analyzed the ablated size, enhancement pattern, shape, margin, and complications of the complete and partial ablation groups. Rabbits were sacrificed after postprocedural CT with an overdose of ketamine, and pathologic findings of the ablated groups were compared with those of the control group. Results: The size of the ablated lesions and the enhancement pattern differed between the completely and partially ablated groups on chest CT. The size of the ablated lesions was increased by 47.1% in the completely ablated group and by 2.1% in the partially ablated group. In the completely ablated group, VX2 tumor showed absolutely no enhancement, whereas only ablated pulmonary parenchyma outside VX2 showed mild enhancement on enhanced CT. In the partial ablated group, a part of VX2 became strongly enhanced on enhanced CT. On microscopic examination, the completely ablated group demonstrated that a viable tumor cell was not visible. In the partially ablated group, however, a viable tumor cell within the surrounding fibrous capsule on the peripheral area of the VX2 was observed. Conclusion: The important CT findings for evaluation of complete and partial RFA are the ablated size and enhancement pattern of the ablated lesion. 목적: 토끼 폐에 이식한 VX2 종양을 전산화 단층 촬영 유도 하 고주파 소작술로 치료한 후 완전 소작과 불완전 소작에 대한 방사선학적 소견의 차이를 알아보고자 한다. 대상과 방법: 성공적으로 VX2 종양이 폐에 이식된 13마리의 토끼(2.5-3 kg)를 이용하였고, 3마리는 대조군으로 고주파 소작술을 시행하지 않았고, 불완전 소작술과 완전 소작술을 각각 5마리에서 시행하였다. 고주파 소작술은 1 cm길이의 17 게이지 냉각침(Radionics, Burlington, MA, U.S.A.)을 이용하여 전산화 단층 촬영(Computed tomography, CT) 유도 하에 시행하 였다. 고주파 소작술 후 추적검사는 고주파 소작술 후 3일이내에 촬영하였으며, 완전 소작술 과 불완전 소작술 후의 소작된 병변의 크기와 조영증강 정도, 모양, 경계, 합병증을 비교하였 다. 토끼는 CT 촬영 후에 케타민을 과량 투여하여 희생시켰으며, 대조군과 고주파 소작술을 시행한 그룹의 조직 소견을 비교하였다. 결과: CT상 완전 소작과 불완전 소작된 경우를 비교하면 소작된 크기와 조영증강 형태에서 차이를 보였다. 완전 소작의 경우 소작된 병변의 크기가 47.1% 증가하였고, 불완전 소작의 경우 소작 병변의 크기가 2.1% 증가를 보였다. 완전 소작된 경우는 조영증강 후 사진에서 종 괴는 전혀 조영증강이 되지 않고, 다만 종괴의 외측에 있는 소작된 정상 폐실질에서만 조영 증강이 되었다. 그러나 불완전 소작의 경우 소작이 되지 않은 종양의 일부가 강하게 조영증 강이 되었다. 병리소견상 완전 소작의 경우 살아있는 종양세포는 보이지 않았지만, 불완전 소 작이 된 경우 주로 주변부에서 종양의 환상의 섬유화 띠 안쪽을 따라 살아있는 종양세포가 관찰되었다. 결론: 고주파 소작술 후 완전 소작술과 불완전 소작술을 예측하기 위한 중요한 CT소견은 소 작된 병변의 크기 증가와 조영증강 유무임을 알 수 있었다.

Radiofrequency Ablation Using a Monopolar Wet Electrode for the Treatment of Inoperable Non-Small Cell Lung Cancer: a Preliminary Report

진공용,한영민,Young Sun Lee,이용철 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.2

Objective: To assess the technical feasibility and complications of radiofrequency ablation (RFA) using a monopolar wet electrode for the treatment of inoperable non-small cell lung malignancies. Materials and Methods: Sixteen patients with a non-small cell lung malignancy underwent RFA under CT guidance. All the patients were non-surgical candidates, with mean maximum tumor diameters ranging from 3 to 6 cm (mean: 4.6 ± 1.1 cm). A single 16-gauge open-perfused electrode with a 2 cm exposed tip was used for the procedure. A 0.9% NaCl saline solution was used as the perfusion liquid with the flow adjusted to 30 mL/h. The radiofrequency energy was applied for 10 40 minutes. The response to RFA was evaluated by performing contrast-enhanced CT immediately after RFA, one month after treatment and then every three months thereafter. Results: Technical failure was observed in six (37.5%) of 16 patients: intractable pain (n = 2) and non-stop coughing (n = 4). The mean follow-up interval was 15 ± 8 months (range: 9 31 months). The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 ± 1.3 cm). Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions. There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1). Conclusion: Although RFA using a monopolar wet electrode can create a large ablation zone, it is associated with a high rate of technical failure when used to treat inoperable non-small cell lung malignancies.

Assessment of Therapeutic Response of Ablated Lesion after Radiofrequency Ablation in Patients with Unresectable Lung Malignancies by Multiphase Contrast-enhanced MRI

진공용,한영민,정경호,황승배,이용철,권근상 대한자기공명의과학회 2011 Investigative Magnetic Resonance Imaging Vol.15 No.3

Purpose: We evaluated which phase was important to recognize local progression of an ablated zone after RFA on multiphase contrast-enhanced MRI (CE-MRI) in patients with unresectable lung malignancy. Materials and Methods: Twenty patients who had unresectable lung malignancy underwent multiphase CE-MRI examinations immediately after RFA. We evaluated the enhancement patterns of the ablated zone on multiphase CE-MRI: type I, no enhancement of the ablated zone; type II, enhancement of the ablated margin; type III, heterogeneous enhancement of the ablated zone. We evaluated the association enhancement type with local progression of the ablated zone on the follow up CT using Spearman’s ranked test. Results: In complete ablation, the enhancement pattern was types I (11.1%) or II (88.9%). In unsuccessfully treated, type II (57.1%) or III (42.9%) pattern observed in the arterial phase. However, types II (21.4%) and III (78.6%) observed in the venous, and types II (7.1%) and III (92.9%) observed equilibrium phases. Local progression of the ablated zone was associated with the enhancement pattern in equilibrium phases (r=0.8, p < .05). Conclusion: Equilibrium phases on multiphase CE-MRI might play a more important role in evaluating an ablated zone for predicting local recurrence after RFA.

범발성 세기관지염 환자에 대한 저용량 에리스로마이신의 임상적 효과: 연속적 고해상 전산화단층촬영과 폐기능 검사를 통해서

진공용,한영민,이흥범,곽효성,정경호 대한영상의학회 2003 대한영상의학회지 Vol.48 No.6

Purpose: To determine evaluate the clinical effectiveness of low-dose erythromycin (EM) therapy in patients with diffuse panbronchiolitis (DPB), and to correlate the pulmonary function testing (PFT) changes seen at serial high-resolution CT (HRCT) withthe results of post-treatment. Materials and Methods:We retrospectively evaluated 13 DPB patients [seven men and six women aged 23-68 (mean, 46.2) years] who had undergone PFT, HRCT, and transbronchial or open lung biopsy prior to long-term, low-dose EM therapy (250 mg twice daily for more than six months). The interval between initial and follow-up study ranged from 7 to 32 (mean, 16.6±8.0) months, and we compared the changes in HRCT findings and PFT parameters before and after treatment. Results: At HRCT after EM therapy, the extent of centrilobular nodules (p=0.006), peripheral bronchiolar wall thickening (p=0.02), and areas of low attenuation (p=0.011) decreased significantly, while FVC and FEV1 showed significant increases: FVC, from 2.47±0.83 to 2.74±0.95 (p=0.028); and FEV1, from 1.66±0.75 to 1.95±0.87 (p=0.02). As the extent of peripheral bronchiolar wall thickening (r=-0.609, p=0.047) and areas of low attenuation (r=-0.687, p=0.041) decreased at serial HRCT, FVC and FEV1 increased significantly. Conclusion: Long-term follow-up HRCT findings showed that for DPB patients, lowdose EM provides effective treatment. In addition, HRCT appears to be valuable for the objective evaluation of responses to EM therapy. 목적: 범발성 세기관지염 환자에 대한 저용량 에리스로마이신(erythromycin)의 임상적 효과를 알아보고, 치료 후 폐기능검사와 연속적 고해상 전산화단층촬영(HRCT)과의 연관성에 대해서 알아보고자 한다. 대상과 방법: 13명의 환자(남자 7, 여자 6)를 후향적으로 분석하였으며, 연령은 23세에서 68세였다(평균, 46.2세). 모든 환자는 폐기능검사와 고해상 전산화단층 촬영을 하였으며, 치료 전에 기관지경 또는 폐 조직검사를 하였다. 모든 환자는 저 용량의 에리스로마이신을 한 번에 250 mg씩 하루에 2회씩 6개월이상 장기간 복용하였으며, 환자의 추적 기간은 7개월에서 32개월이었다(평균, 16.6±8.0개월). 치료 전과 치료 후의 폐기능의 변화와 고해상 전산화단층촬영의 변화를 비교 분석하였다. 결과: 중심 소엽성 결절(centrilobular nodule, p=0.006), 주변성 세기관기벽의 두께(peripheral bronchiolar wall thickening, p=0.02), 저 음영 부위(low attenuation area, p=0.011)가 치료 후 추적 고해상 전산화단층촬영에서 통계적으로 의의 있게 감소하였다. FVC와 FEV1이 저 용량 에리스로마이신으로 치료 후 통계적으로 의의있게 호전되었다: FVC, from 2.47±0.83 to 2.74±0.95 (p=0.028); FEV1, from 1.66±0.75 to 1.95±0.87(p=0.02). 또한, 추적 전산화단층촬영상 주변성 세기관기벽의 두께(r=-0.609, p=0.047)와 저음영 부위가(r=-0.687, p=0.041) 감소할수록 폐 기능은 더욱 호전되었다. 결론: 고해상 단층촬영을 통한 장기간 추적 검사상 저용량의 에리스로마이신은 범발성 세기관지염의 치료에 효과가 있다. 또한, 고해상 전산화단층촬영은 에리스로마이신의 치료 반응에 대한 객관적인 평가에 가치가 있다.

Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: a National Survey of Korean Practice

진공용,김정숙,권근상 대한영상의학회 2008 대한영상의학회지 Vol.59 No.5

Purpose: This study surveyed the thoracic radiologists in Korea in order to determine how they performed percutaneous transthoracic needle biopsy of pulmonary lesions. Materials and Methods: In February 2006, fifty questionnaires were mailed to the members of the Society of Thoracic Radiology in the Republic of Korea (KSTR), and these doctors worked in academic and community hospitals. The survey consisted of multiple-choice questions regarding the radiologist's approach to a transthoracic needle biopsy (the type of practice, the imaging guidance technique, the biopsy technique, monitoring during the procedure, the assessment of pneumothorax after the procedure and the diagnostic accuracy) on the basis of the guidelines of the British Thoracic Society (BTS) and the European Respiratory Society (ERS)/American Thoracic Society (ATS). Results: A total of 39 (66.1%) KSTR members responded. For the biopsy guidance, 16(41.0%) responder performed the procedure under CT guidance, 19(48.7%) responders performed the procedure under fluoroscopy guidance only and 4(10.3%) responders performed the procedure under either CT or fluoroscopy guidance. Fine-needle aspiration was the procedure of choice for eight (20.5%) respondents, whereas 31(79.5%) preferred performing a cutting needle biopsy. Before doing the procedure, 38(97.4%) institutions performed coagulation tests. All the respondents routinely performed follow-up imaging to determine the presence of a pneumothorax. PTNB has an overall diagnostic sensitivity of 95.8%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 93.9% and an accuracy of 92.4%. Conclusion: Although the KSTR members already perform PTNB according to the BTS or ERS/ATS guidelines with excellent results, this survey could be a cornerstone for formulating PTNB guidelines (indications, contraindications, the pre-investigation and post observation after PTNB) in Korea.

흉막폐 아세포종: 1예 보고

진공용,한영민,박학훈,정경호,김종수 대한영상의학회 2002 대한영상의학회지 Vol.47 No.4

Primary pulmonary neoplasms are uncommon in children. One such tumor, pleuropulmonary blastoma (PPB), is very rare, highly aggressive and malignant, and originates from either the lungs or pleura. It contains both mesenchymal and benign epithelial elements that resemble fetal lung, and occurs mainly in children aged less than five. The clinal symptoms often suggest upper respiratory tract infection or pneumothorax, but ultrasonography and chest CT scans depict both a large mass occupying an almost entire hemithorax, and a simple lung cyst. Contrast-enhanced CT demonstrates hetergeneous attenuation and a whorled appearance. 소아연령에서 폐에서 기원한 원발성 종양은 흔하지 않다. 이 중에서 흉막폐 아세포종(Pleuropulmonary blastoma, 이하 PPB)은 소아의 폐, 또는 늑막에서 발생하는 드문 악성종양이며, 조직학적으로 태아의 폐와 유사한 간엽성 조직 성분과 양성 상피성 조직 성분으로 구성되어 있다. 이 종양은 보통 5세 이하에서 발생하는 악성 폐 종양이며, 임상적으로 상기도 감염또는 기흉으로 종종 오진된다. 방사선학적 소견으로는 초음파와 흉부 CT상 일측 흉곽을 차지할 정도의 큰 종괴와 이에 동반된 단순 폐 낭종을 볼 수 있으며, 큰 종괴는 조영증강 CT상 소용돌이 모양의 불균질한 음영을 보인다.

노인환자의 흉부사진

진공용 대한내과학회 2023 대한내과학회 춘계학술대회 Vol.2023 No.0

Effectiveness of Low-Dose Erythromycin Therapy in Diffuse Panbronchiolitis: Assessment with Serial Changes on High-Resolution CT and Pulmonary Function Test

진공용,한영민,이흥범,곽효성,정경호,Jin, Gong-Yong,Han, Yeong-Min,Lee, Heung-Beom,Gwak, Hyo-Seong,Jeong, Gyeong-Ho The Korean Radiological Society 2003 대한영상의학회지 Vol.48 No.6

목적: 범발성 세기관지염 환자에 대한 저용량 에리스로마이신 (erythromycin)의 임상적 효과를 알아보고, 치료 후 폐기능검사와 연속적 고해상 전산화단층촬영 (HRCT)과의 연관성에 대해서 알아보고자 한다. 대상과 방법: 13명의 환자 (남자 7,여자 6)를 후향적으로 분석하였으며, 연령은 23세에서 68세였다(평균,46.2세). 모든 환자는 폐기능검사와 고해상 전산화단층 촬영을 하였으며, 치료 전에 기관지경 또는 폐 조직검사를 하였다. 모든 환자는 저 용량의 에리스로마이신을 한 번에 250 mg씩 하루에 2회씩 6개월 이상 장기간 복용하였으며, 환자의 추적 기간은 7개월에서 32개월이었다(평균,16.6 $\pm$8.0개월).치료 전과 치료 후의 폐기능의 변화와 고해상 전산화단층촬영의 변화를 비교 분석하였다. 결과: 중심 소엽성 결절 (centrilobular nodule, p=0.006),주변성 세기관기벽의 두께 (peripheral bronchiolar wall thickening,p=0.02),저 음영 부위 (low attenuation area,p=0.011)가 치료 후 추적 고해상 전산화단층촬영에서 통계적으로 의의 있게 감소하였다.FVC와 FEV 1 이 저 용량 에리스로마이신으로 치료 후 통계적으로 의의있게 호전되었다: FVC,from 2.47 $\pm$0.83 to 2.74 $\pm$0.95 (p=0.028);FEV1,from 1.66 $\pm$0.75 to 1.95 $\pm$0.87 (p=0.02). 또한, 추적 전산화단층촬영상 주변성 세기관기벽의 두께 (r=-0.609,p=0.047)와 저음영 부위가 (r=-0.687,p=0.041)감소할수록 폐 기능은 더욱 호전되었다. 결론: 고해상 단층촬영을 통한 장기간 추적 검사상 저용량의 에리스로마이신은 범발성 세기관지염의 치료에 효과가 있다. 또한, 고해상 전산화단층촬영은 에리스로마이신의 치료 반응에 대한 객관적인 평가에 가치가 있다. Purpose: To determine evaluate the clinical effectiveness of low-dose erythromycin (EM) therapy in patients with diffuse panbronchiolitis (DPB), and to correlate the pulmonary function testing (PFT) changes seen at serial high-resolution CT (HRCT) withthe results of post-treatment. Materials and Methods: We retrospectively evaluated 13 DPB patients [seven men and six women aged 23-68 (mean, 46.2) years] who had undergone PFT, HRCT, and transbronchial or open lung biopsy prior to long-term, low-dose EM therapy (250 mg twice daily for more than six months). The interval between initial and follow-up study ranged from 7 to 32 (mean, 16.6+/-8.0) months, and we compared the changes in HRCT findings and PFT parameters before and after treatment. Results: At HRCT after EM therapy, the extent of centrilobular nodules (p=0.006), peripheral bronchiolar wall thickening (p=0.02), and areas of low attenuation (p=0.011) decreased significantly, while FVC and FEV1 showed significant increases: FVC, from 2.47+/-0.83 to 2.74+/-0.95 (p=0.028); and FEV1, from 1.66+/-0.75 to 1.95+/-0.87 (p=0.02). As the extent of peripheral bronchiolar wall thickening (r=-0.609, p=0.047) and areas of low attenuation (r=-0.687, p=0.041) decreased at serial HRCT, FVC and FEV1 increased significantly. Conclusion: Long-term follow-up HRCT findings showed that for DPB patients, lowdose EM provides effective treatment. In addition, HRCT appears to be valuable for the objective evaluation of responses to EM therapy.