고에너지 손상에 의한 대퇴골 전자하부 분쇄 골절의 수술적 치료

황철목,전택수,김우식,김상범,김선홍,김규태 대한골절학회 2006 대한골절학회지 Vol.19 No.2

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

황정한,황철목,조영준,김금원,김영중,서재영,임성주,강병성 대한영상의학회 2017 대한영상의학회지 Vol.76 No.1

Purpose: The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. Materials and Methods: A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1–3), moderate (fair, NRS: 4–6), and severe pain (poor, NRS: 7–10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. Results: One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Conclusion: Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients.

비정맥류성 급성 상부위장관 출혈 환자에서 내시경적 금속클립을 참조한 혈관 색전술의 유용성

윤민재,황철목,김호준,조영준,서재영,신병석,엄준영,배석환,강채훈 대한영상의학회 2013 대한영상의학회지 Vol.69 No.2

Purpose: The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. Materials and Methods: We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Results: Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. Conclusion: The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

양성 유방 병변 제거를 위한 초음파 유도 진공 보조 생검의 유용성과 합병증

김금원,조영준,황철목,김대호,오경진,김규순,윤대성 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.3

Purpose: To evaluate the usefulness and complications of ultrasonography (US)-guided vacuum assisted biopsy (VAB) for the removal of benign breast lesions, and the short- and long-term changes after VAB as shown on follow-up US. Materials and Methods: From January 2007 to May 2008, 110 sonographically benign lesions in 62 patients were sampled via US-guided VAB. We prospectively evaluated the sonographic findings 1 week and 6 months after VAB in all patients to determine the presence of residual tumors, hematomas and scarring. We evaluated the prevalence of hematoma, pain, skin dimpling, fibrotic scarring and residual tumors after US-guided VAB, and determined if correlation existed between complications,size of the lesions and lesion pathology. Results: The age of the patients was 15-65 years, with a mean age of 36.5 years. The pathologic diagnoses were fibroadenomas (41.8%, n = 46), fibrocystic changes (30.9%, n = 34), fibroadenomatoid hyperplasias (13.6%, n = 15), fibroadenomatoid mastopathies (6.3%, n = 7), adenoses (3.6%, n = 4), hamartomas (1.8%, n = 2) and phyllodes tumors (1.8%, n = 2). Complications 1 week after the US-guided VAB included hematomas (n = 39, 35.4%), pain (n = 23, 20.9%), fibrotic scars (n = 26,23.68%), residual tumors (n = 4, 3.6%) and skin dimplings (n = 4, 3.6%). Complications 6 months after the US-guided VAB included hematomas (n = 12,10.9%), pain (n = 3 2.7%), fibrotic scars (n = 14, 12.7%), and residual tumors (n = 17,15.4%). Residual tumor after US-guided VAB existed in association with 15.2% of fibroadenomas (7/46), 14.7% of fibrocystic changes (5/34), 13.3% of fibroadenomatoid hyperplasias (2/15), 25% of adenoses (1/4), and 100% of phyllodes tumors (2/2). Conclusion: US-guided VAB is an effective procedure for removal of benign breast lesion. Periodic follow up studies at 1week and 6months after the VAB are useful to assess Post-VAB complications. 목적: 양성 유방 병변 제거를 위한 초음파 유도 진공 보조 생검술 후 단기 추적 검사와 장기 추적 검사를 시행하여 초음파소견 변화를 이해하고, 진공 보조 생검술의 합병증과 유용성을알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2008년 5월까지 본원에서초음파 유도 진공 보조 생검술을 시행한 62명 환자 110개의병소를 대상으로 하였다. 모든 진공 보조 생검술 환자에 대해시술 1주 후와 시술 6개월 후 초음파를 시행하여 혈종, 반흔,잔류 종양의 초음파 소견의 변화 등을 전향적으로 분석하였다. 시술 후 통증, 혈종, 반흔, 잔류 종양, 피부함몰 등 합병증의 빈도와 병변의 크기, 바늘 크기, 병리 결과와의 연관성을 분석하였다. 결과: 환자의 나이는 15-65세로 평균 36.5세였다. 병리적소견은 섬유선종이 46예(41.8%), 섬유성 낭종 질환이 34예(30.9%), 섬유선종성 증식증(15예, 13.6%), 섬유선종성 유병증(7예, 6.3%), 선증(4예, 3.6%), 과오종(2예, 1.8%), 양성 엽상종양(2예, 1.8%)이 있었다. 진공 보조 생검술 시술 1주 후합병증으로 혈종(39예, 35.4%), 통증(23예, 20.9%), 반흔(26예, 23.6%), 잔류 종양(4예, 3.6%), 피부 함몰(4예, 3.6%)이있었으며 6개월 추적검사에서 혈종과 반흔은 감소하였고, 잔류 종양은 더 많이 발견되었다. 혈종은 병변의 크기, 바늘 크기와 유의한 차이가 없었다 (p > .05). 잔류 종양이 있었던 경우진공 보조 생검술의 병리 결과는 섬유선종 15.2% (7/46), 섬유선종성 증식증 13.3% (2/15), 선증 25% (1/4), 섬유성 낭종질환 14.7% (5/34), 엽상종양 100% (2/2)에서 나타났다. 결론: 초음파 유도 진공 보조 생검술은 유방 양성 병변에 대한 간단하고 효과적인 시술로 생각되며 6개월 추적검사에서혈종과 반흔은 감소하였고, 잔류 종양은 더 많이 발견되었다. 초음파는 시술 후 발견되는 합병증을 판단하는데 도움이 되었다.

족부 근육 내 점액종: 증례 보고

신우진,이충식,황철목,장민구,송재황 대한족부족관절학회 2023 대한족부족관절학회지 Vol.27 No.1

Intramuscular myxoma is a rare benign myxoid tumor that is difficult to differentiate from other benign soft tissue tumors and sarcoma, and as a result, intramuscular myxoma is commonly misdiagnosed as another type of soft tissue tumor. Accordingly, awareness of the existence of this condition is a fundamental requirement for treatment decision-making. Furthermore, although intramuscular myxoma appears grossly to be well-circumscribed, it can infiltrate adjacent soft tissue microscopically. Tumor resection is the recommended treatment, but appropriate surgical margin sizes remain controversial. To the best of our knowledge, this is the first South Korean report to be issued on the treatment of intramuscular myxoma of the foot

Reliability of the EOS Imaging System for Assessment of the Spinal and Pelvic Alignment in the Sagittal Plane

김상범,허윤무,황철목,김태균,홍지영,원유건,함창욱,민영기,이진웅 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.4

Background: The sagittal alignment of the spine and pelvis is not only closely related to the overall posture of the body but also to the evaluation and treatment of spine disease. In the last few years, the EOS imaging system, a new low-dose radiation X-ray device, became available for sagittal alignment assessment. However, there has been little research on the reliability of EOS. The purpose of this study was to evaluate the intrarater and interrater reliability of EOS for the sagittal alignment assessment of the spine and pelvis. Methods: Records of 46 patients were selected from the EOS recording system between November 2016 and April 2017. The exclusion criteria were congenital spinal anomaly and deformity, and previous history of spine and pelvis operation. Sagittal parameters of the spine and pelvis were measured by three examiners three times each using both manual and EOS methods. Means comparison t -test, Pearson bivariate correlation analysis, and reliability analysis by intraclass correlation coefficients (ICCs) for intrarater and interrater reliability were performed using R package “irr.” Results: We found excellent intrarater and interrater reliability of EOS measurements. For intrarater reliability, the ICC ranged from 0.898 to 0.982. For interrater reliability, the ICC ranged from 0.794 to 0.837. We used a paired t -test to compare the values measured by manual and EOS methods: there was no statistically significant difference between the two methods. Correlation analysis also showed a statistically significant positive correlation. Conclusions: EOS showed excellent reliability for assessment of the sagittal alignment of the spine and pelvis.

유방암의 광범위한 관내 상피암 성분 및 조직학적 등급을 예측할 수 있는 영상 소견

한혜연,김금원,박용성,조영준,황철목,김현진,설혜정,윤대성,김규순 대한영상의학회 2009 대한영상의학회지 Vol.61 No.6

Purpose: To evaluate the usefulness of US and mammography in detecting extensive intraductal component (EIC) in invasive cancer and correlating the results with the histopathologic grade. Materials and Methods: We retrospectively reviewed the mammographic and sonographic features of 125 invasive breast cancers, classified as “invasive cancer with EIC” (n=57) and “invasive cancer without EIC”(n=68). The mammographic features are classified as microcalcifications only, microcalcifications beyond the soft tissue density, soft tissue density without microcalcification, and sonographic features classified according to ten sonographic suspicious features for malignancy by Stavros. We calculated sensitivities, specificities, positive predictive value, negative predictive value, and accuracy to correlate them with histologic grade. Results: Microcalcifications on mammography, calcification, duct extension, and a branching pattern on sonography were found to be statistically significant predictors of EIC. Also, a thick echogenic halo, angular margin, microlobuation, taller than wide feature on sonography, and soft tissue shadow without microcalcification on mammography showed a decreased risk of EIC. In addition, the presence of a branching pattern is an indicator of high histologic grade (p<0.05). Conclusion: Microcalcification on mammography, calcification, duct extension, and branching pattern on sonography are an indicator of the presence of EIC in invasive cancer. In addition, when a branching pattern is present, the tumor tends to have a high histologic grade. 목적: 침윤암 내의 광범위한 관내 상피암 성분(extensive intraductal component, 이하 EIC)의 유무와 EIC가 있는 침윤암의 조직 등급을 예측할 수 있는 영상 소견에 대해 알아보았다. 대상과 방법: 수술로 확진된 125개의 침윤암 중 EIC가 없는 침윤암(n = 68)과, EIC가 있는 침윤암(n = 57)의 유방 촬영술과 초음파 소견을 후향적으로 분석하였다. 유방 촬영술은 미세 석회화만 있는 경우, 연부 조직 음영 바깥에 미세 석회화가 있는 경우, 미세 석회화 없이 연부조직 음영만 있는 경우 등으로 분류하였고, 초음파 소견은 Stavros 등이 제시한 10가지 소견에 따라 분류하여 EIC 존재 여부에 대한 민감도, 특이도, 정확도, 양성예측도, 음성예측도를 구하였다. 또한, 각 영상 소견과 조직 등급과의 관계를 알아보았다. 결과: EIC를 시사하는 영상 소견은 유방 촬영술에서 미세 석회화나 연부 조직 음영 바깥의 미세 석회화, 초음파에서 석회화, 관내 뻗침, 가지 치는 유형이었다. 이와 달리 유방 촬영술에서 종괴 음영만 있고 초음파에서 각진형 경계, 미세소엽형, 너비보다 높은 경우 EIC의 가능성은 떨어졌다. 조직 등급은 초음파상 가지 치는 유형이 있는 경우 높아졌다(p < 0.05). 결론: 유방 촬영술에서 미세 석회화, 초음파에서 석회화, 관내 뻗침, 가지 치는 유형은 EIC를 시사한다. 이 중에서 가지 치는 유형이 있을 경우, EIC의 조직 등급은 높아지는 경향이 있다.

폐 병소의 생검 중 기흉 발생시 CT 투시 유도하 생검의 유용성

오동현,조영준,박용성,황철목,김금원,김지형 대한영상의학회 2006 대한영상의학회지 Vol.55 No.2

시상면 균형과 관련된 골반지표의 방사선학적 특성

김상범,이기수,원유건,전준범,황철목,홍창화 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

연구 계획: 척추 변형의 치료 시 골반지표의 방사선학적 특성에 대한 고찰. 목적: 이 문헌은 척추의 시상 정렬, 골반 지표, 정렬을 측정하는 방법을 평가하고, 이 지표들 사이의 관계를 연구하여 척추의 변형을 이해하고자 한다. 선행문헌의 요약: 척추와 골반의 시상면상 주요 지표들을 파악하고 서로의 상관관계를 아는 것은 여러 가지 척추 질환의 진단과 치료에 있어서 매우 중요하다. 대상 및 방법: 문헌 고찰결과: 골반 및 척추의 지표들은 상호간에 밀접한 상관관계의 양상을 보이므로 시상면 균형을 분석하는데 척추 지표뿐만 아니라 골반 지표를 계측하는 것은 필수적이다. 퇴행성 변화는 정상 척추의 만곡을 손상시킬 가능성이 있고, 이는 시상 부정정렬을 일으키게 된다. 시상 균형의 분석은 척추의 질환을 이해 하는데 중요한 요소이다. 또한, 수술적 치료의 결과는 방사선학적 척추-골반 지표와 이들의 변형의 관계를 이해함으로써 잘 판단 할 수 있다. 결론: 시상 정렬과 균형 그리고 보상기전의 관계를 인지하기 위한 척추와 골반 지표의 이해는 척추 변형의 본질과 이를 치료하는데 있어 포괄적인 개념을제공 한다. Study design: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity. Objectives: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. Summary of Literature Review: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. Materials and Methods: Review of the literature. Results: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. Conclusions: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.

삼중음성 유방암과 Estrogen Receptor/Progesteron Receptor 양성 유방암의 영상의학적 소견 비교

김영중,김금원,김대호,조영준,황철목,서재영,김진숙,윤대성,김규순 대한영상의학회 2013 대한영상의학회지 Vol.68 No.6

Purpose: To retrospectively investigate the imaging [mammographic, ultrasonographic (US), magnetic resonance (MR) imaging] features and standardized uptake values (SUV) in positron emission tomography (PET)/computed tomography (CT) of triple-negative breast cancers (TNBC) and to compare them with breast cancers that are either estrogen receptor (ER) positive or progesteron receptor (PR) positive. Materials and Methods: 155 breast cancers cases were identified in 134 women (mean age, 51 years; range, 31-86 years). Surgically confirmed TNBC (n = 27) and ER-positive/PR-positive breast cancers (n = 81) were included among them. Cancers were investigated with mammography (n = 81), US (n = 106), MR imaging (n = 34) and PET-CT (n = 59). Mammographic findings are identified by detection of characteristic masses and microcalcifications. US findings included tumor size, margin, tumor shape, calcification and posterior shadowing. MR findings included tumor size, shape, margin, internal enhancement, intratumoral signal intensity and kinetics. Peak SUVs (p-SUV) of breast cancers were evaluated in PET/CT. These findings were compared with TNBC and ER/PR positive groups. Results: Mammographic findings had no significant association with the TNBC. High pathological grade (p < 0.05), larger than 2 cm in size, well-marginal mass, and round or oval-shaped (p < 0.05) is US were significantly associated with TNBC. In MR imaging, round mass shape (p < 0.05), well-circumscribed mass margin (p < 0.05), rim enhancement (p < 0.05), were significantly associated with TNBC. The peak SUV of TNBC tend to be higher than that of ER-positive/PR-positive breast cancer (7.95 ± 5.50 vs. 4.91 ± 3.00, p < 0.05). Conclusion: TNBC tend to have high pathological grade, are of a large, round and smooth mass with rim enhancement on MR and US. In addition to above features, PET-CT with SUV estimation can improve the accuracy of test through the evaluation of TNBC. 목적: 삼중음성 유방암과 estrogen receptor (ER)/progesteron receptor (PR) 양성 유방암의 영상 소견을 비교하여 분석하고, positron emission tomography (PET)-CT에서 얻은 최대 standardized uptake values (SUV) 값을 평가하여, 삼중음성 유방암을 예측할 수 있는지 알아보고자 하였다. 대상과 방법: 조직학적으로 유방암이 확진된 134명의 환자(평균 나이 51세, 31~86세) 155예의 유방암을 대상으로 하였다. 이 중 삼중음성 유방암(27예)과 ER/PR 양성 유방암(81예)이 수술적으로 확진되었고, 유방 촬영술(81예), 초음파(106예), 자기공명영상(34예), PET-CT (59예)를 시행하였다. 각 종괴의 조직학적 등급을 평가하였고, 유방 촬영술 영상은 종괴와 석회화 여부, 초음파에서는 종괴 크기, 변연, 모양, 석회화와 후방 음향, 자기공명영상에서는 종괴 크기, 모양, 변연, 내부 조영증강, 종양 내 신호 강도와 역동적 조영증강으로 나누어 평가하였다. PET-CT에서는 최대 SUV값을 측정하였다. 삼중음성 유방암과 ER/PR 양성 유방암군으로 나누어 위의 소견들에 대하여 비교 평가하였다. 결과: 유방 촬영술 소견은 두 군 간에 유의한 차이가 없었다. 삼중음성 유방암일 경우 조직학적 등급이 높게 나타났고, 초음파 소견은 삼중음성 유방암에서 크기가 2 cm 이상이며, 변연이 잘 그려지고, 모양이 둥글거나 난원형을 보이는 것으로 나타났다(p < 0.05). 자기공명영상에서는 삼중음성 유방암일 경우, 종괴 모양이 둥글고, 변연이 잘 그려지며, 테두리 조영증강을 보이는 특징이 있는 것으로 나타났다(p < 0.05). PET-CT에서 최대 SUV값은 삼중음성 유방암에서 ER/PR 양성 유방암보다 유의하게 높았다(7.95 ± 5.50 vs. 4.91 ± 3.00, p < 0.05). 결론: 삼중음성 유방암은 자기공명영상과 초음파에서 조직학적 등급이 높고, 크기가 크고, 모양이 둥글고, 변연이 잘 그려지며, 테두리 조영증강을 보인다. 추가적으로 최대 SUV를 평가하면, 삼중음성 유방암을 예측하는 데 도움이 될 것이다.