Early HCC Transarterial Approach: From Palliative Therapy to Curative Therapy

천호종 대한간암학회 2011 대한간암연구회 학술심포지엄 Vol.15 No.-

간암에서 인터벤션 치료의 실제

천호종 ( Ho Jong Chun ) 대한간학회 2019 간질환 연수강좌 Vol.2019 No.1

간암의 방사선색전술

천호종 ( Ho Jong Chun ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1

Radioembolization is an emerging treatment modality in patients with hepatocellular carcinoma (HCC) and is a form of brachytherapy in which intra-arterially injected Ytrrium-90 microspheres are used for internal radiation purpose. Ytrrium-90 is a high energy beta particle-emitting radioisotope. Ytrrium-90 microspheres administered via arterial route direct the highly concentrated radiation to the tumor while normal liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. Main complications do not result from the microembolic effect, even in patients with portal vein thrombosis, but rather from an excessive irradiation to the non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series. When compared to the standard of treatment for the intermediate and advanced stages (TACE and sorafenib), radioembolization consistently provides similar survival rates. Many randomized controlled trials using radioembolization are underway and will provide optimal evidences as standard treatment for unresectable HCC.

간암에서 인터벤션 치료의 실제

천호종 ( Ho Jong Chun ) 대한간학회 2019 춘·추계 학술대회 (KASL) Vol.2019 No.1

Radioembolization in Hepatocellular Carcinoma

Ho Jong Chun(천호종) 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4

Radioembolization is an emerging treatment modality in patients with hepatocellular carcinoma (HCC) and is a form of brachytherapy in which intra-arterially injected Ytrrium-90 microspheres are used for internal radiation purpose. Ytrrium-90 is a high energy beta particle-emitting radioisotope. Ytrrium-90 microspheres administered via arterial route direct the highly concentrated radiation to the tumor while normal liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. Main complications do not result from the microembolic effect, even in patients with portal vein thrombosis, but rather from an excessive irradiation to the non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series. When compared to the standard of treatment for the intermediate and advanced stages (TACE and sorafenib), radioembolization consistently provides similar survival rates. Many randomized controlled trials using radioembolization are underway and will provide optimal evidences as standard treatment for unresectable HCC.

양전자 방출 단층촬영 검사에서의 흉곽내 비악성 FDG 집적

박현진,유이령,천호종,송선화,임수아,박석희,김성훈,이교영 대한영상의학회 2007 대한영상의학회지 Vol.57 No.1

Fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) has been used exclusively to diagnose malignancies. However, increased FDG uptake is not always limited to malignant tissue. Many false positive findings for PET have been reported. Moreover, the use of PET/CT may allow the reassessment of previously recognized patterns of physiological bio-distribution of a tracer. In this report we demonstrate the physiological FDG uptake of normal structures in the thorax using PET/CT imaging and illustrate many benign pathological conditions with standardized uptake values greater than 2.5. 지금까지 악성 질환의 진단에 18FDG-양전자 방출 단층촬영 검사(PET)가 널리 쓰이고 있다. 그러나 PET에서 FDG 집적이 반드시 악성 조직에서만 이루어지는 것이 아니며 이는 지금까지의 여러 연구결과를 통해 알려졌다. 이후 PET/CT의 개발 덕분에 FDG의 생체 내 생리학적 분포에 대해서 알려지게 되었고, 따라서 이전에 PET만으로 설명할 수 없었던 FDG 집적에 관한 재분석이 이루어졌다. 이에 저자들은 PET/CT를 통하여 흉곽 내에의 정상구조물에 의한 정상적인 FDG 집적과 정상구조물의 생리학적 변화로 인한 FDG 집적 그리고 마지막으로 양성질환에 의한 FDG 집적의 예들을 열거하고자 한다.

Liver Transplantation after Successful Downstaging with Hepatic Arterial Infusion Chemotherapy in a Patient with Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

남희철,성필수,천호종,김동구,장정원,최종영,윤승규 대한간암학회 2019 대한간암학회지 Vol.19 No.1

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The majority of patients with HCC are diagnosed at advanced disease stages with vascular invasion, where curative approaches are often not feasible. Currently, sorafenib is the only available standard therapy for HCC with portal vein tumor thrombosis (PVTT). However, in many cases, sorafenib therapy fails to achieve satisfactory results in clinical practice. We present a case of advanced HCC with PVTT that was treated with hepatic arterial infusion chemotherapy (HAIC) followed by liver transplantation. Three cycles of HAIC treatment resulted in necrotic changes in most of the tumors, and PVTT was reduced to an extent at which liver transplantation was possible. Further studies are required to determine the treatment strategies for advanced HCC with PVTT that can improve prognosis.

Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

오정석,이해규,천호종,최병길,최영진 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.1

Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

전산화 단층촬영에서의 심비대 기준

김유성,박현진,박석희,천호종,최병길 대한영상의학회 2007 대한영상의학회지 Vol.57 No.3

Purpose: To determine computed tomography (CT) criteria for cardiomegaly. Materials and Methods: We analyzed posteroanterior chest radiographs and CT scans of 200 patients (M:F=130:70, mean age 49 years old) that were performed on the same day. On plain radiographs, the cardiothoracic ratio (R) was calculated using a standard method. On CT, we measured the maximal cardiac width (Dc) and the maximal thoracic width of a patient (Dt1). A second thoracic width was measured at the same scan level of Dc. Thus, two cardiothoracic ratios were derived in one patient-Dc/Dt1 (R1) and Dc/Dt2 (R2). We analyzed the appropriateness of R1 and R2 in the diagnosis of cardiomegaly to establish criteria for the use of the cardiothoracic ratio (ROC curve). Results: When cardiomegaly was defined as a value of R that was greater than 0.5, both R1 and R2 were useful indicators of cardiomegaly. For a cut-off value of 0.5 for the cardiothoracic ratio for cardiomegaly, the sensitivity of R1 and R2 was 84% and 68%, respectively, and the specificity of R1 and R2 was 72% and 86%, respectively. Conclusion: The cardiothoracic ratio on CT can be easily obtained by measurement of the maximal cardiac width divided by the maximal thoracic width at the same scan level. When the cardiothoracic ratio on CT is over 0.5, the presence of cardiomegaly can be suggested. 목적: 전산화단층촬영에서 심비대의 기준을 제시한다. 대상과 방법: 단순흉부촬영과 전산화단층촬영을 같은 날 시행한 200명(남자 130명, 여자 70명, 평균연령 49세)의 심흉비를 각각의 영상에서 측정하였다. 단순흉부촬영에서는 흉곽이 가장 긴 부위에 대한 심장의 최대직경의 비를 계산하여 심흉비(R)를 산출하였고, 전산화단층촬영에서는 모든 단면영상에서 가장 긴 심장의 횡경(Dc)과 가장 긴 흉곽의 횡경(Dt1), 가장 긴 심장의 횡경을 측정한 단면에서의 흉곽의 횡경(Dt2)을 측정한 후 가장 긴 심장 횡경에 대한 두 흉곽 횡경의 비(R1=Dc/Dt1, R2=Dc/Dt2)를 얻었다. 심비대 진단에서 전산화단층촬영에서 산출된 심흉비(R1, R2)의 유의성을 분석하였고, 산출된 심흉비의 심비대 기준값을 알아보았다(ROC 곡선). 결과: 단순흉부촬영에서 심흉비가 0.5 이상인 경우를 심비대라고 할 때, 전산화단층촬영에서 두가지 방법으로 측정한 심흉비(R1, R2) 모두 심비대 평가에 유용하였다. 그리고 전산화단층촬영에서 얻은 두 심흉비의 심비대 기준을 0.5로 적용하였을 때, R1과 R2의 각각의 민감도는 84%와 68%, 특이도는 72% 와 86%이었다. 결론: 전산화단층촬영에서 가장 긴 심장의 횡경과 그 단면에서의 흉곽의 횡경의 비가 0.5 이상이면 심비대가 있다고 말할 수 있다.

Consolidations in Nodular Bronchiectatic Mycobacterium Avium Complex Lung Disease: Mycobacterium Avium Complex or Other Infection?

임수아,박현진,박석희,천호종,정원상,김성훈 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.4

Purpose: The objective of this study is to define the clinical implications of consolidations in nodular bronchiectatic type Mycobacterium avium complex (NBMAC)infection. Materials and Methods: A total of 69 patients (M : F = 17 : 52;mean age, 64 years; age range, 41-85 years) with MAC isolated in the sputum culture and nodular bronchiectasis on the initial and follow-up CT scans were included. We retrospectively reviewed the incidence of consolidation and analyzed its clinical course by using radiographic changes with or without anti-MAC drug therapy. Results: In 44 of the 69 cases (64%), focal consolidations were seen on the initial and follow-up CT images. In 35 of the 44 (80%) cases, consolidations completely regressed, and in 3 cases (7%), consolidations partially regressed within 2 months with only antibiotics. In 2 cases (5%), the consolidations remained stable for over 2 months without anti-MAC drug therapy. Only in 4 cases (9%) did the consolidations improve after anti-MAC drug therapy. In 11 of the 38 cases (29%) with responsiveness to antibiotics, non-mycobacterial micro-organisms were identified in sputum, including pseudomonas, hemophilus, staphylococcus, and others. Conclusion: In NB-MAC, consolidations are commonly present on CT. In these conditions, most of consolidations result from pneumonia other than MAC.