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재발성화농성담관염: 다중시기 나선식 CT의 국소감약차이와 임상.병리 소견의 연관성$^1$
한준구,김태경,김석준,김현범,Han, Jun-Gu,Kim, Tae-Gyeong,Kim, Seok-Jun,Kim, Hyeon-Beom 대한영상의학회 2002 대한영상의학회지 Vol.46 No.2
목적: 재발성화농성담관염 환자의 다중시기 나선식 CT에서의 국소감약차이(focal attenuation differences; FAD)와 담관벽 조영증강의 임상적,병리적 의미를 파악하고자 하였다. 대상과 방법:60명 환자의 다중시기 (조영전기, 동맥기, 간문맥기)CT영상을 분석하였다. 조영 전기를 기준으로 두 가지 형태의 FAD(Type A: iso, Type B: low attenuation)를 볼 수 있었으며 FAD의 빈도, 형태와 분포양상 (엽성 분포 또는 반점형, 다병소성 분포) 및 담관벽 조영 증강을 분석하여 임상소견 및 병리결과와의 연관성을 알아보았다. 결과: 총 40명의 환자에서 FAD를 관찰할 수 있었다.Type A FAD를 보인 27명 환자 중 19명은 임상적으로 활동성 염증 상태였고 Type B FAD를 보인 13명중 10명은 임상적으로 염증의 증거가 없었다. CT상 FAD가 있었고 병리로 확인된 환자에서 Type A FAD를 보인 15명중 10명은 활동성 염증이 있었고 Type B FAD를 보인10명중 9명은 만성염증 상태로 판명되었다.FAD를 보이지 않은 20명중 18명은 임상적으로 염증의 증거가 없었으며, 병리로 확인된 11명중 9명에서 잠복성(dormant)염증 상태를 보였다 (p<0.001). 그러나, FAD의 분포 형태와 담관벽의 조영증강은 임상.병리소견과 통계적 연관성이 없었다. 결론: 재발성화농성담관염 환자에서 다중시기의 CT에서의 FAD를 관찰함으로써 염증의 활성도를 예측할 수 있다. Purpose: To determine the clinical and the pathologic significance of the focal attenuation differences (FAD) and bile duct wall enhancement occurring in recurrent pyogenic cholangitis (RPC) and seen at multiphasic spiral Materials and Methods: Among the multiphasic (non-contrast, arterial and portal or delayed phase) spiral CT findings of 60 consecutive patients, two types of FAD were noted during the non-contrast phase. These were Type A (iso) and Type B (low attenuation), and their distribution pattern (lobar versus patchy, multifocal) and the and the presence or absence of bile duct wall enhancement were recorded. The radiologic findings were correlated with the clinical and pathologic findings. Results: Two types of FAD were noted in 40 of the 60 patients. Active in flammation was present in 19 of the 27 with Type-A and in ten of the 15 in whom the presence of RPC was pathologically proven. Ten of the 13 with Type-B FAD were in a subclinical state, and nine of the ten in whom RPC was pathologically proven had chronic inflammation. Among 20 patients who did not have FAD, RPC was subclinical in 18 and dormant in nine of the eleven in whom its presence was pathologically proven (P<0.001). Clinico-pathologic correlation with bile duct wall enhancement and the distribution pattern of FAD showed no statistical significance. Conclusion: The inflammatory activity of RPC can be predicted by analysis of the FAD seen at multiphasic spiral CT.
한준구,박재형,김형석,박길선,이구,김승협,최병인,한만청,이효석,김정룡,Han, Joon-Koo,Park, Jae-Hyung,Kim, Hyung-Suk,Park, Kil-Sun,Lee, Goo,Kim, Seung-Hyup,Choi, Byung-Ihn,Han, Man-Chung,Lee, Hyo-Suk,Kim, Chung-Yong 대한영상의학회 1990 대한영상의학회지 Vol.26 No.4
Hepatocellular carcinoma(HCC) is one of the most common malignancies in Korea. Despite of recent advances in diagnostic and surgical technics, early diagnosis of HCC is difficult and chance of surgical resection is still very low because of the multiplicity of tumors and associated liver cirrhosis. Transarterial chemoembolization(TAE) is a proven effective mean of treating HCC whether it is operable or not. The authors analyzed the survival data from 193 patients of HCC who were diagnosed and had undergone TAE in Seoul national University Hospital from February 1987 to January 1988. Methods of TAE were the infusion of mixture of Lipiodol and Adriamycin with or without following administration of Gelfoam soaked in Mitomycin C. One year survival rate of all 193 cases was 53%. One year survival rate was affected by the presence and the degree of arteriovenous(AV) fistula as well as Child class, stage of the disease and degree of arteriovenous(AV) fistula as well as Child class, s age of the disease and degree of portal vein involvement. One year survival rte was 55.9% for Child class A, 46.9% for class B, 35% for class C, and 58.4% for stage I, 46.9% for stage II, and 38.9% for stage III. Patients who had the involvement of main portal vein revealed one year survival rate of 30.6%, whereas 44.1% for the patients who had the involvement of first order branch and 60.5% for the patients who had no involvement of portal vein or involvement was noted in smaller branches. Patients who had AV fistula of grade(┼┼) ahd one year survival rate of 18.5%, 27.6% for (┼) group, and 60.1% for(-)group. Patients who had undergone Gelfoam embolization after the infusion of Lipiodol-Adriamycin mixture had one year survival rate of 57.3% whereas who had not undergone gelfoam embolization revealed one year survival rate of 47 %. These results suggest that TAE is a very effective mean of treating HCC and the presence of AV firstula is one on the poor prognostic factors of HCC. A though this study lacks comparison between the same clinical groups, it is suggested that Gelfoam embolization after the infusion of Lipiodol-Adriamycin mixture may improve the prognosis of the patients.
가토간에 유발한 VX2암종의 발견을 위한 Superparamagnetic Iron Oxde 조영증강MRI의 적정 Sequence$^1$
한준구,이경호,최병인,Han, Jun-Gu,Lee, Gyeong-Ho,Choe, Byeong-In 대한영상의학회 2003 대한영상의학회지 Vol.48 No.1
목적: 이 실험 연구의 목적은 악성다발간종양 평가에 가장 적절한 superparamagnetic iron oxide (이하 SPIO)조영증강자기공명영상(이하 MRI)기법을 밝히는 것이다. 대상과 방법: 간에 VX2암종을 다발성으로 심은 12 마리 가토에, 총 9 가지 서로 다른 기법을 이용한 SPIO조영증강MRI를 시행하였다. 포함된 기법은 급속스핀에코T2강조 및 양자밀도강조영상과 에코시간을 다양하게 변화시킨 (7 msec, 12 msec, 15 msec, 35 msec)경사에코$T2^*$강조 영상이었다. 종양과 간실질의 대조잡음비를 정량적으로 평가하였고, 판독자 두 명의 합의에 의 해 종양경계의 명확성과 영상인공물의 정도를 4등급으로 평가하였다. 각 기법의 종양 발견예민도와 양성예측도는 육안병리조직과의 비교를 통하여 구하였다. 결과: 대조잡음비는 급속스핀에코 T2강조영상과 긴에코시간(35 msec)의 경사에코 $T2^*$강조기법에서 가장 높았고, 종양경계의 명확성은 급속스핀에코T2강조영상과 중간정도에코시간(12msec)의 경사에코$T2^*$강조기법들에서 가장 뚜렷하였으며 영상인공물의 영향이 가장 적은 기법은 짧은에코시간 (7 msec)의 경사에코$T2^*$강조영상이었다. 종양발견예민도는 중간정도에코시간(12 msec)의 경사에코기법들 (FLASH 84%; FISP 82%)과 T2강조영상(79%)및 양자밀도강조영상 (76%)의 급속스핀에코가 우수하였다. 양성예측도는 모든 기법에서 대체로 우수하였고 (86%-97%)각 기법간에 통계적으로 유의한 차이가 없었다 (p>.05). 결론: 이 실험연구에서 SPIO조영증강MRI의 여러 기법 중 급속스핀에코T2강조영상과 중간에코시간 (12 msec)의 경사에코$T2^*$강조영상이 가장 높은 영상의 질과 우수한 종양발견율을 보여간의 다발암종의 평가에 가장 적절한 기법으로 생각된다. Purpose: The purpose of this experimental study was to determine the optimal pulse sequences for SPIO-enhanced MR imaging in the evaluation of multiple hepatic tumors. Materials and Methods: Twelve rabbits with multiple VX2 liver tumors underwent SPIO-enhanced MRI using the following nine pulse sequences: TSE T2-weighted imaging (T2WI), TSE proton density-weighted imaging (PDWI), and GRE $T2^*$-weighted imaging ($T2^*$WI) with seven different echo times (TE). Liver-lesion contrastto-noise ratios (CNRs) were calculated, and images were also assessed qualitatively by two radiologists, who reached a consensus as to lesion conspicuity and imaging artefacts using a four-level scale. By means of pathologic correlation, the sensitivity and positive predictive value of each sequence was calculated. Results: TSE T2WI and long-TE (35 msec) FLASH $T2^*$WI showed the highest liver-lesion CNR. The best lesion conspicuity was seen at TSE T2WI and medium-TE (12 msec) GRE $T2^*$WI. Short TE GRE T2*WI showed the least imaging artefacts. The four sequences which demonstrated the best sensitivity were medium-TE (12 msec), GRE $T2^*$WI (FLASH, 84%; FISP, 82%), TSE T2WI (79%), and TSE PDWI (76%). All nine sequences showed overall high positive predictive value (86-97%), with no statistically significant difference (p>0.05). Conclusion: In terms of image quality and the detection of sensitivity, TSE T2WI and medium TE (12 msec) GRE $T2^*$WI were the top two pulse sequences among the various sequences used for on SPIO-enhanced MRI. They are thus considered to be the optimal sequences for evaluating multiple malignant hepatic tumors.