경피적 골생검

허진도 대한영상의학회 1989 대한영상의학회지 Vol.25 No.5

Forty three percutaneous bone biopsy(PBB)procedures were performed under fluoroscopic guide at department of diagnostic radiology of Kosin Medical College Pusan Korea. the overall accuracy was 88.4% (38/43)true positive rate was 74%(32cases) true negatice was 14% (6cases) false negative was 12%(5 cases). In cases of suspected metastasis with or without known primary PBB occasionally provided the final tissue diagnosis and was helpful in tumor staging and seeking the primary site. In cases of primary bone tumor the tissue diagnosis obtained by PBB was hekpful for planning future therapy and confirmed the recurrent tumor and residual lesion following treatment. There wan no serious complication related to PBB. In conclusion PBB is simple safe economic and accurate diagnostic tool PBB gave the final tissue diagnosis. It not only provided accurate tumor staging and future therapeutic plan before treatment and also helped in the management of follow-up in patients with recurrent or residual lesion.

한국정상성인 요로계의 X선학적 계측에 관한 연구

허진도 대한영상의학회 1982 대한영상의학회지 Vol.18 No.2

The review of normal intravenous pyelography can give us important criteria of the diseases of the urinary system and the adjacent organs. Authors analyzed 200 cases of intraveous pyelography of normal Korean adults and measured the following points; the length of kidneys, the distance from midline to both poles, the slope degree of longitudinal axis, the ureteral length and width, the shortest distance from midline to abdominal ureters, the longest distance from midline to prelvic ureters, and configuration of urinary bladder. The results were obtained as follows: 1. The average length of kidneys in adult male was 12.53$\pm$0.78cm on right, 12.83$\pm$0.82cm on left; in adult female, 12.08$\pm$0.72cm on right, 12.46$\pm$0.73cm on left. In the age distribution, the length gradually became shorter by getting old. In 20% o f cases, right kidney was longer than left. 2. The average distance from both the renal poles to midline was longer in male compared to female. The distance from upper pole to the midline was longer in left side than right in male, but in the lower pole, there was no difference in both sexes. 3. The slope degree of the renal longitudinal axis was larger in male than in female, and larger in right kidney compared to left. 4. The length of ureter was longer on left, but there was no remarkable difference between both sexes. 5. The shortest distance from midline to abdominal ureter, there was no remarkable difference between both sexes and also between right and left side. But concerning the longest distance from midline to pelvice urter, it was longer I female; and especially in female, right side was shorter than left. 6. The longitudinal diameter of urinary bladder was longer in male, but horizontal diameter was longer in female.

CT분석에 의한 요근징후의 재고찰

허진도 대한영상의학회 1986 대한영상의학회지 Vol.22 No.6

The lateral margin of the psoas muscle, contrasted by retroperitoneal fat, is usually visualized on plain abdominal radiography. Failure to visualize all or segment of lateral margin of the psoas muscle, so called psoas sign, has been emphasized as reliable finding of retroperitoneal pathology. But the significance of psoas sign has been controversial. The authors reevalueated 'psoas sign' by comparing 160 abdominal radiographs with CT. The results were as follows : 1. In 160 supine radiographs, good visualizaton was present in 106 cases(66.3%), faint visualizaton in 24 (15.05), segmental nonvisualization in 18 (11,3%), and complete nonvisualization in 12(7.5%). In 113 erect radiographs, good visulaization was present in only 36 cases (31.95). 2. Asymmetric visualization was present in 84 out of 160 cases. In patients with scoliosis, lateral margin of convex side was seen more clearly than co cave side, and this findings was statistically significant (P<0.005). 3. Ascites did not directly influence to psoa visualization , contrary to common belief. 4. In 54 cases of faint or nonvisualization , normal was 16 (29.6%), and retroperitoneal pathology was 22(40.7%). 1) In normal patient, psoas contact with kidney or intestine and deformed psoas muscle were responsible for poor visualizaton. 2) The major cause of poor visualization in intraperitoneal pathology were psoas contact with displaced kidney by hepatomegaly. ascites with scant retroperitoneal fat and deformed psoas muscle. 3) The major cause of poor visualizationin retroperitoneal pathology were psoas invasion by tumor or inflammation, psoas contact with enlarged kidney or perirenal lesion. 5. In summary, the mechanism of faint or nonvisualization of psoas margin were. 1) psoas contact with normal or pathologic organs 2) psoas invasion by tumor or inflammation 3)deformed psoas muscle 4) scanty retroperitonela fat

골다공증의 방사선학적 진단의 최신동향

허진도,조영덕,정규식,김소선 고신대학교(의대) 고신대학교 의과대학 학술지 1993 고신대학교 의과대학 학술지 Vol.9 No.2

-Abstract- Early detection of osteoporosis is important and accurate evaluation for the progression and response to therapy should be seriously monitored. Efforts have been made in the development of methods for quantitatively assessing the bone mass so that osteoporosis can be detected early. There is no consensus on which method are most effective for the diagnosis and monitor of osteoporosis or screening of large populations. The selection of anatomic sites and methods for quantifying bone mass is considerably important. Knowledge about the proper use and interpretation of various bone densitometry studies is not universal among physicians. Discussions are focused on understanding instrumentation and interpretation of various technical performance of bone density measurement. Dual X-ray absorptiometry (DXA), Dual photon absorptiometry (DPA) and quantitative computed tomography (QCT) and other methods measuring bone density are presented and their inherent limitations are discussed. We anticipate that newer softwares of instrumentations will be available for a more accurate, versatile and convenient way of measuring bone mineral density.

초치료 폐결핵환자에 있어서 결핵성 공동의 임상적 및 방사선학적 고찰

허진도 대한영상의학회 1986 대한영상의학회지 Vol.22 No.2

Tuberculous cavity is important in diagnosis and observation in the course of pulmonary tuberculosis. Authors anlayzed the radiologic findings of cavity and average months of negative conversion in AFB culture in 89 cases of initial treatment. The results were as follows : 1. The more number of cavities, the longer period in negative conversion of AFB culture. 2. No relation between sums of diameter and thickness of cavity and average months of negative conversion in AFB culture. In the cases of cavity with air-fluid level took longer period in negative conversion of AFB culture than those of cavity without air-fluid level, significantly. 4. No relation between radiolgic findings of cavity and results of chemotherapy for pulmonary tuberculosis.

흉요추 이행부의 경막내 고충증 1예

허진도 대한영상의학회 1991 대한영상의학회지 Vol.27 No.4

Sparganosis is a rare parasitic disease usually involving muscle and subcutaneous tissue. Man serves as an accidental intermediate host of sparganum, plerocercoid of spirometra subgenus. Spinal sparganosis is extremely rare, and only 4 cases have been reported in the literature. We describe a case of sparganosis affecting the intradural extramedullary space of the thoracolumbar junction. Myelography revealed an irregular intradural filling defect with complete block below the T-10 level. MRI showed a mild hyperintense lesion in the posterolateral portion of the intradural sac on T2WI and patchy enhancement on Gd-DTPA enhanced T1WI. The findings are consistent with granulation tissue related to sparganum. If there is a long segment involvement with a complete block at the cervicothoracic or thoracolumbar junction, no associated bony destruction, and a patient history of consuming snakes or frogs, sparganosis may be considered in the differential diagnosis.

악성 골반 골종양에 의한 천장관절의 경관절 침습

허진도,조길호,김성민,조영덕,Heo, Jin-Do,Jo, Gil-Ho,Kim, Seong-Min,Jo, Yeong-Deok 대한영상의학회 2002 대한영상의학회지 Vol.46 No.3

목적: 종양의 위치, 천장관절의 해부학적 구조와 위치, 관절강직증 유무, 그리고 종양이 형성하는 연부 조직 종괴의 양상에 따라 악성 골반 골종양이 천장 관절로 경관절 침습하는 방식을 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 골반골에서 발생한 악성 골종양 환자 중, 영상소견에서 천장 관절을 침범하여 상대편 골(opposing bone)의 골 파괴가 있는 11명의 환자를 대상으로 하였다. 골종양의 발생위치와 크기를 알아보았으며, 천장관절의 침범부위를 위치에 따라 상부, 중간, 하부 침습으로 분류하였고, 해부학적 차이에 따라 활막 유리질 연골 부위(synovial hyaline cartilage portion)와 섬유성 연골 인대 부위(fibrous ligamentous portion)침습으로 나누었다. 관절의 강직증 유무에 따라 경관절 침습 양식을 비교하였다. 천장관절로의 경관절 침습 양식은 연골을 파괴하고 직접적으로 관절을 가로질러 넘어가는 직접 침습(direct invasion)과 연부 조직 종괴가 상대편 골피질에 인접하여 관절 주변부와 상대편 골(opposing bone)을 침범하는 간접 침습(indirect invasion)으로 분류하였다. 결과: 종양은 전예에서 천장 관절 근처에서 발생하였고, 장골이 8예, 천골이 3예였다. 천장관절의 간접 침습은 6예, 직접 침습은 5예였다. 천장관절의 간접 침습에서 종양의 크기는 평균191.8 cm2 이었고, 직접 침습에서는 평균 69.6 cm2이었다. 천장관절의 간접침습은 모든 예에서 큰 연부조직 종괴가 천장관절 주변부에서 관절과 접하고 있었다. 상부에서 발생한 간접 침습의 5예는 모두 관절 후방의 섬유성 연골 인대 부위를 침범하였으나 종양과 인접한 활막 유리질 연골은 침범하지 않았다. 하부에서 발생한 1예에서는 활막 유리질 인대를 유지하면서, 관절강을 우회하여 상대편 골(opposing bone)의 골피질을 파괴하였다. 이중 관절강직증은 1예에서 보였다. 직접 침습 역시 비교적 큰 연부 조직 종괴가 관찰되었으며, 관절 상부에서 발생한 2예와 중간부위에서 발생한 1예는 관절 후방의 섬유성 연골 인대를 침습하였다. 관절 강직증을 동반한 2예만 하부의 활막 유리질 연골을 통하여 직접 침습을 하였다.결론: 악성 골반 골종양의 경관절 침습은 대부분이 섬유성 연골 인대부분을 통하여 천장관절 을 침습한다. 관절강직증이 동반된 경우 활막 유리질 연골 파괴를 통한 천장관절 침습이 가 능하다. 또한 골반 골종양은 천장관절을 가로질러 침습하기 보다는 큰 연부 조직 종괴가 천장관절과 접한 후, 관절 주변부(periphery)로부터 관절 또는 상대편 골(opposing bone)로의 파급되는 것으로 생각된다. Purpose: To describe modes of transarticular invasion, with reference to the size and location of a tumor, the anatomic characteristics of invaded cartilage, and the existence of ankylosis in SI joint. Materials and Methods: Eleven histologically confirmed malignant pelvic bone tumors involving transarticular invasion of sacroiliac joints, were retrospectively analysed. Transarticular invasion of a joint was defined as involvement of its opposing bones. The anatomic site and size of the tumors were analysed, and invaded sacroiliac joint was divided into upper, middle and lower parts on the basis of the anatomic characteristics of the intervening cartilage: synovial hyaline or fibrous ligamentous. The existence of ankylosis was determined, and transarticular invasion directly across a joint was classified as direct invasion. Extension of tumors around a joint from its periphery to the opposing bone were considered as indirect invasion. Results: All tumors were located near the sacroiliac joint, eight at the ilium and three at the sacrum. Six invasions were indirect and five were direct. Average tumor area was larger in indirect cases than in direct: 191.8 cm2 vs. 69.6 cm2. In all indirect invasions, a huge soft tissue mass abutted onto the peripheral portion of the sacroiliac joint. In five of six cases of indirect transarticular invasion, the upper part of the joint posteriorly located fibrous ligamentous cartilage. In the other, the lower part was invaded, and this involved a detour around the joint space, avoiding the invasion of intervening cartilage. Ankylosis occurred in one of the indirect cases. Among the five cases of direct invasion, there was invasion of the posteriorly located ligamentous fibrous cartilage in three without ankylosis. In the other two cases, involving ankylosis, the synovial hyaline cartilage was invaded directly at the lower part of the joint. Conclusion: Transarticular invasions of sacroiliac joint via fibrous cartilage are most common. Ankylosis of the sacroiliac joint facilitates hyaline cartilage invasion. We consider that in transarticular invasion of malignant pelvic bone tumors, indirect invasion is more common than direct.

골다공증의 방사선학적 진단의 최신동향

허진도,조영덕,정규식,김소선 고신대학교 의학부 1993 高神大學校 醫學部 論文集 Vol.9 No.2

Early detection of osteoporosis is important and accurate evaluation for the progression and response to therapy should be seriously monitored. Efforts have been made in the development of methods for quantitatively assessing the bone mass so that osteoporosis can be detected early. There is no consensus on which method are most effective for the diagnosis and monitor of osteoporosis or screening of large populations. The selection of anatomic sites and methods for quantifying bone mass is considerably important. Knowledge about the proper use and interpretation of various bone densitomety studies is not universal among physicians. Discussions are focused on understanding instrumentation and interpretation of various technical performance of bone density measurement. Dual X-ray absorptiometry(DXA). Dual photon absorptiometry(DPA) and quantitative computed tomography(QCT) and other methods measuring bone density are presented and their inherent limitations are discussed. We anticipate that newer softwares of instrumentations will be available for a more accurate. versatile and convenient way of measuring bone mineral density.

자기공명영상 (MRI)의 임상적 이용도 추세와 전망

조영덕,허진도,전봉진,김소선,정규식,김종민 釜山醫師會 1994 釜山醫師會誌 Vol.30 No.11

골격외 유잉육종의 영상 소견

정경순,허진도,정미희,고지호,이은정,이승룡 대한영상의학회 2005 대한영상의학회지 Vol.53 No.3

Purpose: The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. Materials and Methods: Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. Results: The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm (mean, 5.2 cm), were mainly well circumscribed and showed no evidence of calcification prior to treatment. Margins were well defined in four out of the six patients. Four patients had subcutaneous lesions and the other two patients had intramuscular lesions. Muscle (two patients) and bone invasion (one patient) were present. The masses were heterogenous low signal intensity on T1 weighted images and heterogeneous high signal intensity on T2 weighted images compared with muscle. Heterogeneous enhancement within the lesion was observed in all patients on CT and MRI. Whole body scintigraphy using Tc-99 m MIBI showed increased uptake in the masses of two patients. Conclusion: Extraosseous Ewing's sarcomas were frequently seen as a well-circumscribed ovoid mass with nonspecific findings on CT and MRI. Despite being a relative rare tumor, it should be included in the differential diagnosis of a non-calcified soft-tissue mass, especially in subcutaneous tissue. 목적: 골격외 유잉육종의 영상소견을 분석하고 감별진단에 도움이 되는 소견이 있는지 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 6명을 대상으로 후향적으로 분석하였다. 단순촬영은 모든 환자에서 시행하였으며, MRI가 5예, CT가 3예였으며 전신 섬광조영술(whole body scintigraphy)을 2예에서 시행하였다. CT나 MRI에서 종괴의 위치, 크기, 경계, 주위 조직과의 관계를 분석하였다. MRI 에서는 종괴의 신호강도, CT에서는 종괴의 음영을 관찰하였다. 또한 MRI와 CT에서 종괴의 균질성과 조영증강정도를 살펴보았다. 결과: 종괴의 위치는 대퇴부(thigh)가 3예로 가장 많았고, 배부(back)가 2예, 상지가 1예였다. 종괴의 크기는 장경을 기준으로 평균 5.2 cm이었다. 4예에서 주위 정상 조직과의 경계가 잘 구분되었다. 피부하(subcutaneous)가 4예, 근육내(intramuscular)에 위치하는 경우가 2예였다. 주위 근육을 침범한 예가 2예, 골을 침범한 경우가 1예였다. 전예에서 내부는 불균질성을 보였고 MRI를 시행한 5예 중 4예는 T1강조영상에서 주위 근육과 비교하여 저신호강도를 보였으며 T2강조영상에서는 모두 불균질한 고신호강도를 보였다. 전예에서 불균질한 조영증강을 보였다 Tc-99 m MIBI를 이용한 전신 섬광조영술을 시행한 2예에서 종양부위의 섭취가 증가되었다. 결론: 골격외 유잉육종은 비교적 경계가 분명한 종괴로 MRI나 CT에서 비특이적인 소견을 보이지만 비교적 젊은 연령에서 석회화가 없는 불균질한 연부조직 종양이 피부하에서 발생할 때 비록 드물지만 감별진단에 포함해야 할 것으로 생각한다.