이행성 협심증 환자에서 운동부하 심전도 검사

이정우,박형서,박용규,노상필,이유선,정승현,김보영,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

목적 : 관상동맥의 경련에 의한 이형성 협심증환자에 있어서 운동부하 심전도 검사의 결과는 매우 다양하다. 이에 저자들은 충남대학교병원 순환기내과에서 관상동맥조영술상 이형성 협심증으로 확진된 환자를 대상으로 운동부하 심전도 검사를 시행하여 이에 대한 결과를 연구하였다. 방법 : 1995년 1월부터 2002년 3월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥조영술을 시행하여 관상동맥의 내경이 50% 미만의 협착이 있고, 에르고노빈(ergonovine) 유발검사도 이형성 협심증으로 진단을 받은 233명중 운동부하 심전도 검사를 시행 받은 183명의 환자를 연구 대상으로 하였다. 운동부하 심전도 검사 결과의 판독시 발생할 수 있는 오류를 줄이기 위해서 운동부하 심전도 검사를 시행하기전 심전도상 ST분절의 상승(5예)이나 하강(8예)이 있는 경우 EH한 T파의 역위(19예)가 있는 32명의 환자를 제외한 총 151명의 환자를 대상으로 하였다. 운동부하는 Marquette사의 case 15 답차를 이용하였고, Bruce protocol에 따라 증상이 나타날 때까지 최대로 실시하였으며 각 stage 및 운동후의 혈압을 측정하고 12 유도 심전도를 기록하였다. 결과 : 1) 임상적 특성 - 내원시 임상 상은 안정형 협심증이 39예(25.8%), 불안정형 협심증이 103예(68.2%), 심근경색증이 9예(6.0%)이었다. 운동부하 심전도 검사 결과 양성 군과 음성군간에 있어서 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연 여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도, 연축의 수 등을 조사하였는 바 어떠한 인자들도 유의한 차이를 발견할 수 없었다. 2) 운동부하 심전도 검사 - 운동부하 심전도 검사를 시행 받은 151명의 환자중 음성인 경우는 134예(88.8%)이었고, 양성인 경우는 17예(11.2%)이었다. 양성 소견을 보인 환자들중 ST 분절의 상승이 4예(2.6%), ST 분절의 하강이 13예(8.6%)이었다. 3) 관상동맥조영술 - 관상동맥조영술상에서 혈관 경력 위치는 우관상동맥이 70예(46.1%), 좌전하동맥이 44예(28.9%), 좌회선동맥이 17예(11.2%)의 순으로 나타났다. 운동부하 심전도 검사상 ST 분절의 상승이 있었던 예중 Ⅱ, Ⅲ, aVF에서 ST 분절의 상승이 있었던 1예는 관상 동맥조영술상 우관상동맥에서 경련이 발생하였고, V2-V4에서 ST 분절의 상승이 있었던 2예중 관상동맥조영술상에도 좌전하행동맥에서 경련이 나타난 예는 1예이었으며 다른 1예는 좌회선동맥에서 경련이 나타났고, V5-V6에서 ST 분절의 상승이 있었던 1예는 관상동맥조영술상에도 좌회선동맥에서 경련이 나타났다. 운동부하 심전도 검사상 V5 또는 V6에서 ST 분절의 하강이 있엇던 13예중 6예(46.1%)는 관상동맥조영술상 우관상동맥에서 경련이 발생하였고, 3예(23.1%)는 좌전하행동맥에서, 1예(7.7%)는 좌회선동맥에서, 나머지 3예(23.1%)는 2개의 혈관이나 기타 분지에서 경련이 발생하였다. 결론 : 1) 이형성 협심증 환자는 운동부하 심전도 검사에서 11.2%의 양성소견을 보였다. 이중 ST 분절의 상승은 2.6%이었고, ST 분절의 하강은 8.6%이었다. 2) 이형성 환자중 운동부하 심전도 검사를 실시하여 음성을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 3) 이형성 협심증 환자중 운동부하 심전도 검사를 실시하여 ST 분절의 상승을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 4) 운동부하 심전도 검사 결과에 대한 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도 등 어떠한 인자들도 3그룹(ST 분절의 상승, ST 분절의 하강, 음성)간에 유의한 차이를 발견할 수 없었다. 5) ST 분절의 상승 부위와 관상동맥조영술상 관상동맥의 연축이 일어나는 혈관과의 상관관계는 매우 높았다. No reports in the literature describe the results of exercise testings in a large number of patients with pure variant angina(coronary stenosis <50%) in Korea. In this report, We present the results of treadmil exercise testing in 151 patients with variant angina. 151 patients with angiographically proven coronary artery spasm underwent a treadmil exercise test. The clinical characteristics of variant angina patients classified according to ST-segment response to exercise were analyzed. Of 151 patients underwent a treadmil exercise test, negative result was seen in 134 patients(88.8%) and positive result was in 17 patients(11.2%). Of 17 patients saw positive result, exercise-induced ST segment elevation was present in 4 patients(2.6%) and ST segment depression was seen in 13 patients(8.6%). There was not a significant relationship between the ST segment response to exercise and the clinical variables(diabetes, hypertension, obesity, total cholesterol, current smoking, effort angina, clinical diagnosis, and degree of stenosis) assessed. Of 4 patients with ST segment elevation in treadmil exercise test, 1 patient with ST segment elevation in Ⅰ,Ⅲ,aVF had spasm in right coronary artery(100%) on coronary angiography, of 2 patients in V2-V4 had spasm in left anterior descending coronary artery in 1 patient(50%) and 1 patient in V5-V6 had spasm in left circumflex artery(100%). Positive treadmil exercise test was present in 11.2% of variant angina patient. If we have negative treadmil exercise result in patients with clinical manifestation of unstable angina at admission, we may have a suspicion of variant angina rather than multi-vessel disease. If we have exercise-induced ST segment elevation in patients with clinical manifestation of unstable angina at admission, we have a suspicion of variant angina rather than multi-vessel disease. Our result suggests that the correlation between the site of the ST segment elevation and the artery involved is quite good.

Regulation of Hepatic Gluconeogenesis by an ER-Bound Transcription Factor, CREBH

Lee, Min-Woo,Chanda, Dipanjan,Yang, Jianqi,Oh, Hyunhee,Kim, Su Sung,Yoon, Young-Sil,Hong, Sungpyo,Park, Keun-Gyu,Lee, In-Kyu,Choi, Cheol Soo,Hanson, Richard W.,Choi, Hueng-Sik,Koo, Seung-Hoi Elsevier 2010 Cell metabolism Vol.11 No.4

<P><B>Summary</B></P><P>Endoplasmic reticulum (ER)-bound transcription factor families are shown to be involved in the control of various metabolic pathways. Here, we report a critical function of ER-bound transcription factor, CREBH, in the regulation of hepatic gluconeogenesis. Expression of CREBH is markedly induced by fasting or in the insulin-resistant state in rodents in a dexamethasone- and PGC-1α-dependent manner, which results in the accumulation of active nuclear form of CREBH (CREBH-N). Overexpression of constitutively active CREBH activates transcription of <I>PEPCK-C</I> or <I>G6Pase</I> by binding to its enhancer site that is distinct from the well-characterized CREB/CRTC2 regulatory sequences in vivo. Of interest, knockdown of CREBH in liver significantly reduces blood glucose levels without altering expression of genes involved in the ER stress signaling cascades in mice. These data suggest a crucial role for CREBH in the regulation of hepatic glucose metabolism in mammals.</P> <P><B>Highlights</B></P><P>► PGC-1α/GR activates CREBH expression under fasting or insulin-resistant conditions ► CREBH enhances hepatic gluconeogenesis via a CRTC2-dependent manner ► Depletion of CREBH in the liver ameliorates fasting hyperglycemia in diabetic mice</P>

Glucotoxicity in the INS-1 Rat Insulinoma Cell Line Is Mediated by the Orphan Nuclear Receptor Small Heterodimer Partner

Park, Keun-Gyu,Lee, Kyeong-Min,Seo, Hye-Young,Suh, Ji-Ho,Kim, Hye-Soon,Wang, Li,Won, Kyu-Chang,Lee, Hyoung-Woo,Park, Joong-Yeol,Lee, Ki-Up,Kim, Jung-Guk,Kim, Bo-Wan,Choi, Hueng-Sik,Lee, In-Kyu American Diabetes Association 2007 Diabetes Vol.56 No.2

<P>Prolonged elevations of glucose concentration have deleterious effects on beta-cell function. One of the hallmarks of such glucotoxicity is a reduction in insulin gene expression, resulting from decreased insulin promoter activity. Small heterodimer partner (SHP; NR0B2) is an atypical orphan nuclear receptor that inhibits nuclear receptor signaling in diverse metabolic pathways. In this study, we found that sustained culture of INS-1 cells at high glucose concentrations leads to an increase in SHP mRNA expression, followed by a decrease in insulin gene expression. Inhibition of endogenous SHP gene expression by small interfering RNA partially restored high-glucose-induced suppression of the insulin gene. Adenovirus-mediated overexpression of SHP in INS-1 cells impaired glucose-stimulated insulin secretion as well as insulin gene expression. SHP downregulates insulin gene expression via two mechanisms: by downregulating PDX-1 and MafA gene expression and by inhibiting p300-mediated pancreatic duodenal homeobox factor 1-and BETA2-dependent transcriptional activity from the insulin promoter. Finally, the pancreatic islets of diabetic OLETF rats express SHP mRNA at higher levels than the islets from LETO rats. These results collectively suggest that SHP plays an important role in the development of beta-cell dysfunction induced by glucotoxicity.</P>

관상동맥 질환에서 SDF-1α의 농도

김보영,박용규,박형서,노상필,정승현,이유선,이정우,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Atherosclerosis is now viewed as an inflammatory disease of the vascular system. Expression of several chemokines, including monocyte chemoattractant protein(MCP)-1, MCP-4, RANTES(regulated on activation normal T-cell expressed and secreted), and interleukin-8(IL-8) are increased in human atherosclerotic plaques compared with normal vessels. They are involved in the pathogenesis of atherosclerosis and plaque rupture by activating and directing leukocytes into the atherosclerotic lesions. However, some are involved in homeostatic functions such as normal leukocyte traffic and growth regulation. SDF-la is a multi-functional cytokine that is involved in myelogenesis, hematopoiesis, angiogenesis and injured gastric mucosal regeneration in the gastric ulcer patient. SDF-la is recently shown to be highly expressed in atherosclerotic plaques and a potent platelet agonist. At least in high concentrations, SDF-la may mediate antiinflammatory and matrix stabilizing effects in unstable angina. Many studies are going on to know the function of SDF-la in coronary artery diseases. I investigated the difference of the plasma level of SDF-la between control group and coronary artery disease group. Total 75 subjects were enrolled. The diagnosis of coronary artery disease was confirmed in all patients by coronary angiography. Control subjects in this study were confirmed normal by coronary angiography. Clinical profile and risk factors were also reviewed. Control subjects in this study were 27 (M=10, F=17). Plasma for the study was collected before the angiography and centrifuged. SDF-la analysis was performed by ELISA. Plasma level of SDF-la is significantly increased in patients with stable angina(n=20) and unstable angina group(n=28) compared with healthy control group(n=27). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases. In this study, plasma level of SDF-la is increased in patients with stable angina and unstable angina groups compared with healthy control group(P<0.05). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases.

흰쥐의 장기에서 납과 카드뮴의 감소에 미치는 두충 추출물의 효과

이인규,김종규 대한보건협회 2000 대한보건연구 Vol.26 No.1

This study was performed to investigate the possible effects of Korean Eucommia ulmoides Oliv(EuO) extract on the reduction of lead(Pb) and cadmium(Cd) accumulation in organs of rats. Seventy 4-week old male Spraue-Dawley rats were used for this experiment. They were divided into the following 10 groups and fed for 4 weeks: The control group; two groups treated with only Pb, one with 100 ppm and one with 200 ppm; two groups treated with only Cd, one with 50 ppm and one with 100 ppm; a group treated with only EuO(3% extract); four groups treated with a combination of both EuO and one of each level of Pb(100 ppm and 200 ppm) and Cd(50 ppm and 100 ppm). The EuO and the heavy metals were orally administered in drinking water. The water intake of the Pb-EuO and the Cd-EuO combination groups showed significantly lower than those of control group, the EuO alone group, and the Pb alone and the Cd alone groups(p<0.05). The EuO alone group showed higher body weight compared to the Pb and Cd treated groups at the termination(p<0.05). The levels of Pb and Cd in the liver, kidney, heart, lung, stomach and spleen of the rats exposed to Pb alone and Cd alone were reduced by the combined treatment of EuO. The significant differences of Pb levels were observed among the lungs of the EuO alone group, the Pb alone groups, and the Pb-Euo combined groups(p<0.05). There were significant differences in the Cd levels in the lung and the stomach among the three groups; the EuO alone group, the Cd alone groups, and the Cd-Euo groups(p<0.05). The highest levels of Pb and Cd were found in the kidney, and they were reduced by more than 50% by the addition of EuO. These results indicate that the 3% extract of E. ulmoides Oliv could be helpful for the reduction of Pb and Cd accumulation in the organs of rats, and suggest that it may be effective in excreting the heavy metals. We need to check what levels of E. ulmoides Oliv are practical for human beings to consume and what level will cause other negative results.

영양교육프로그램이 용인지역 초등학생들의 식품섭취빈도와 기호도에 미치는 효과

이인경;이동현;김상연;배인영;이현규 한양대학교 2012 韓國 生活 科學 硏究 Vol.32 No.1

The purpose of this study was to investigate the effect of nutritional education program on the consumption frequency and preference of food in elementary school students in Yong-In. Nutrition education was conducted with 6 weeks. The results show as follow. 1) The subject consisted of 11 boys and 9 girls. 55% of Mothers had job and 70% of students were participated by recommending from their parents. 2. Consumption frequency of grains and starches of the students were not significantly different after nutrition education. However, consumption frequency of sausage and ham of the students significantly decreased after nutrition education. Consumption frequency of anchovy, beans, paprika and brocoli, milk, yogurt, and cheese of the students significantly increased after nutrition education. 3. The preference of foods such as chicken, duck meat, blue fish, white fish, cheese, soybean milk, mushroom, egg apple, fruits, fruits juice, soda, and traditional beverages of the students significantly increased after nutrition education. However, The preference of ice-cream, fried chicken, pizza of the students significantly decreased after nutrition education. These results indicate that a well-designed program for nutritional education program can help to change the consumption frequency and preference of food.

Theoretical and experimental analysis of the source resistance components in In0.7Ga0.3As quantum-well high-electron-mobility transistors

Lee In-Geun,Ko Dae-Hong,Yun Seung-Won,Kim Jun-Gyu,Jo Hyeon-Bhin,Kim Dae-Hyun,Tsutsumi Takuya,Sugiyama Hiroki,Matsuzaki Hideaki 한국물리학회 2021 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.78 No.6

Herein we describe theoretical and experimental analysis of the source resistance (Rs) components in In0.7Ga0.3As/ In0.52Al0.48As quantum-well (QW) high-electron-mobility transistors (HEMTs) on an InP substrate. First, we analytically modeled Rs using a three-layer formula, separately modeling the regions of the ohmic contact, the gate-to-source access, and the side-recessed regions. The resistances of the ohmic contact and access regions were analyzed in a distributed-network manner with two different transfer lengths, whereas the resistance associated with the side-recess region near the gate edge was modeled by using a lumped element. To verify the accuracy of the proposed Rs model, we fabricated two different types of transmission-line-method (TLM) test patterns as well as long-channel In0.7Ga0.3As/ In0.52Al0.48As QW HEMTs, and compared their measured and modeled Rs. The modeled Rs was in excellent agreement with the measured Rs from the recessed TLM patterns and the long-channel HEMTs. Since the widths of the ohmic contact to the heavily doped In0.53Ga0.47As capping layer and the gate-to-source access region were typically much greater than corresponding transfer lengths ( L T_cap and L T_barrier ), those distributed networks could be simplified to a lumped-element based one-layer model, revealing that the tunneling resistance ( R barrier ) through the In0.52Al0.48As barrier should be carefully considered to minimize the Rs of InxGa1− xAs QW HEMTs together with S/D contact resistances and LGS.

된장이 고지방 및 고콜레스테롤 식이를 급여한 흰쥐의 지질 대사에 미치는 영향

이인규,김종규 대한보건협회 2002 대한보건연구 Vol.28 No.3

OBJECTIVE: This study was performed to investigate the effects of dietary supplementation of Korean traditional soybean paste(doen-jang) on the changes of serum biochemical components and histopathological changes of organs in rats fed a high fat and/or a high cholesterol diet. DESIGN: This was a single open-group prospective clinical intervention. METHODS: A total of one-hundred and twenty eight 3-weeks old male Sprague-Dawley rats were divided into 16 groups by a randomized blocking method. The rats consumed one of the experimental diets, the control diet, a high fat diet(40% of the total calories), a high cholesterol diet(1% of the total weight), and a high fat and high cholesterol diet for 13 consecutive weeks. Each of these diet groups were divided into 4 groups one with no soybean paste added, one with just 0.5% soybean paste added, one with 1% soybean paste added, and one with 5% soybean paste added. These levels were taken from the data of the National Nutrition Survey of Korea from 1994 to 1998. From this data, we know that Koreans on an average eat less than 0.5% soybean paste per person, per day. A Korean traditional soybean paste was used for this study. All of the preparation methods for the soybean paste followed the recommendations of Korea Food Research Institute. After ripening 6 months it was incorporated into the diet. Blood specimens were obtained at the baseline and after 13 weeks of dietary intervention. At the end of the study the organs(liver, heart, and kidney) were excised, and pieces of the organs were taken for histopathological examinatoin. Fool intake, body weight, food efficiency ratio, relative organ weights, and fecal lipid levels were determined at the end of the experiment. RESULTS: The feeding of a high fat and/or a high cholesterol diet resulted in many deleterious effects including increased food intake, increased weight gain, increased organ weights, increased fecal lipid levels,increased serum triglyceride, total lipid, free-cholesterol, easter-cholesterol, total cholesterol, low-density lipoprotein(LDL) cholesterol level, and atherogenic index, and increased lipase, aspartate aminotransferase(AST), alanino aminotransferase(ALT), cholinesterase(ChEase), and lactate dehydrogenase(LDHase) activities, and decreased high-density lipoprotein(HDL) cholesterol level, and most significantly severe fatty changes, in the livers, compared with the control and soybean paste control groups. The feeding of 0.5% soybean paste reduced the adverse effects of the high fat and/or the high cholesterol diet on the food efficiency ratio, weight gain, relative organ weights, fecal lipid levels, and improved serum lipid component levels. Significant decreases(p<0.05) in triglyceride, total lipid, total cholesterol, and LDL-cholesterol were seen. A significant increase was found in the level of HDL-cholesterol(p<0.05). A decrease was observed in atherogenic index. Also it recovered the levels of lipase, AST, ALT, ChEase, and LDHase activities. No significant changes in levels of serum free-cholesterol and easter-cholesterol were observed. It was helpful to reduce the severs histopathological lesions of livers. Although changes in these findings were observed in all of the groups with soybean paste, the most profound inhibitory changes were evident at the 5% level of soybean paste in the results of histological study of livers. In each group, adding soybean paste reduced the adverse effects of a high fat and/or a high cholesterol diet in ratio to the amount of soybean paste added to the diet. CONCLUSIONS: Dietary supplementation of 0.5% soybean paste resulted in reductions in several risk factors for lipid metabolism in rats, fed a high fat and/or a high cholesterol diet especially improved serum lipid component levels and the histopathological lesions of the livers. The feeding of 1% and 5% soybean paste showed even more reduction of risk factors. These results suggest that Korean soybean paste has a protective effect on a high fat and/or a high cholesterol diet. Long-term, placebo-controlled clinical trials are needed to evaluate the effect of soybean paste on the lipid metabolism in the human population.

표면근전도와 적외선체열촬영을 이용한 요통의 평가

이강진,최인성,이소영,한재영,이삼규,채홍재,이성과,문재동 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3

목적 : 요통환자에서 요통의 유무와 강도를 평가하고자 표면근전도를 이용하여 근육 활동성의 차이를 검증하였고 적외선체열촬영을 이용하여 제표면 온도의 변화를 측정하였다. 방법 : 요통환자군 16명과 대조군 16명에 대하여 요부에 부착한 표면전극에서 얻은 근전도 신호와 적외선체열촬영 결과를 비교하였다. 교란요인의 영향을 배제하기 위하여 연령과 성별 그리고 비만도에 따라 정상 대조군과 요통환자군을 짝짓기하여 각각 16명씩 선정하였다. 결과 : 정적표면근전도 실시 결과 우측의 경우 중앙값이 요통환자군에서 198.1 ㎶, 정상대조군에서는 161.3 ㎶로 통계적으로 유의한 차이가 있었고(p<0.01), 좌측은 요통환자군에서 194.2 ㎶, 정상대조군에서 180.5 ㎶로 유의한 차이는 없었다. 동적표면근전도 실시 결과 재신전시와 굴곡시 근전위의 비가 우측의 경우 요통환자군에서 중앙값이 1.12였고 정상 대조군은 1.39로서 두 군간에 유의한 차이가 있었고(p=0.027), 좌측의 경우도 요통환자군에서는 1.08이었고 정상 대조군에서는 1.21로 유의한 차이가 있었다(p=0.036). 적외선체열촬영결과 ΔT가 0.5 ℃ 이상의 차이가 있을 때 이상이 있는 것으로 정하면, 요통환자군에서는 16명 모두 이상자로 판정되었고, 정상 대조군에서는 16명중 3명이 이상자로 판정되어 민감도는 100 %, 특이도는 81.3 % 였다. 표면근전도를 이용한 요통의 진단은 민감도가 78.6 %이고 특이도가 72.2 %였으며, 적외선체열촬영은 민감도가 100 %였고 특이도가 87.5 %였다. 결론 : 이러한 결과로 볼 때 표면근전도 검사법과 적외선체열촬영은 요통을 간접적으로 평가하는데 도움이 되는 검사법이며, 적외선체열촬영이 표면근전도검사법에 비하여 보다 정확한 검사법으로 판단된다. Objectives : We studied the efficacy of surface electromyography(SEMG) and digital infrared theimographic imaging (DITI) in the assessment of low back pain both(LBP) Methods : We compared electromygraphic signals from electrodes placed in the lumbar area and the digital theimographic images in 16 LBPpatients and 16 control subjects. The LBP patients and the control subjects were matched for age, gender, and body mass index(BMI) to adjust for any confounding effects Results : In the static analyses of SEMG, median value was 198.1 ㎶ for the controls on the right side, and they were 194.2 ㎶ and 180.5㎶ on left side respectively. There was a statistically significant difference between the two groups on the right side(p<0.01), but not on the left side. In the dynamic analyses of the SEMG, the median values of the extension per flexion ratio of right side were 1.12 for LBP patients and 1.39 for controls. and those on the left side were 1.08 and 1.21 respectively. There were statistically significant differences in both sodes(p<0.05). The sensitivity and specificity were 100% and 81.3% in DITI, 78.6% and 72.2% in SEMG. Conclusions : These results indicate that SEMG and DITI are useful methods for indirect assessments of LBP, and that DITI is more sensitive and specific than SEMG.

절제된 정상위벽의 자기공명영상기법에 관한 연구:조직소견과의 비교

서보경,설혜영,이남준,차인호,정규병,김정혁,박철민,이지영,Seo, Bo-Gyeong,Seol, Hye-Yeong,Lee, Nam-Jun,Cha, In-Ho,Jeong, Gyu-Byeong,Kim, Jeong-Hyeok,Park, Cheol-Min,Lee, Ji-Yeong 대한영상의학회 2001 대한영상의학회지 Vol.45 No.5

목적:급속자기공명영상기법을 이용하여 절제된 정상위벽을 관찰하고,이를 조직소견과 비교 연구하여,위벽의 관찰을 위한 최적기법을 찾고자 하였다. 대상과 방법:25명 환자의 모두 41개 절제된 정상위조직을 수술후 수지(polyethylene)통에 넣고,생리식염수로 채워 자기공명영상을 시행하였다.T1강조FLASH,지방억제T1강조FLASH, T2강조TSE와 True-FISP 등 4가지 기법으로 위조직의 영상을 얻었다.자기공명영상에서는 위벽의 층수와 각층의 신호강도를 관찰하였고,이를 조직소견과 비교하였다.자기공명영상소견을 조직소견과 비교한 후 위벽 각층의 명확성과 각층간의 구분,및 전체 영상의 질에 대하여 비교하였다.4가지 기법 중 가장 좋은 방법은 3,가장 나쁜 방법은 0으로 하여 등급을 판정하였다. 결과:자기공명영상에서 위벽의 층수는 T1강조FLASH에서 2층이 41예 중 6예(14.6%),3층 31예(75.6%),및 4층 4예(9.8%)였고,지방억제T1강조FLASH에서 2층 6예(14.6%)와 3층 35예(85.4%),T2강조TSE에서 3층 24예(58.5%),4층 11예(26.8%),및 5층 6예(14.6%)였으며,True-FISP에서 1층 2예(4.9%),2층 8예(19.5%),3층 23예(56.0%),4층은 4예(9.8%), 및 5층 4예(9.8%)이었다.위벽의 신호강도는 T1강조FLASH와 지방억제T1강조FLASH에서 2층으로 보인 예는 위내강으로부터 고-중등도,3층인 경우는 고-저-고/중등도,4층인 예는 고-저-고-중등도신호강도였다.T2강조TSE에서는 3층으로 보인 예는 등도/고-저-중등도,4 층인 경우는 중등도-저-고-중등도/저,5층인 예는 저-고-저-고-저신호강도였다.자기공명 영상소견을 조직소견과 비교하였을 때 위벽이 3층으로 보인 경우 이것은 “점막층-점막하층-근층 ”에 해당하였다.관찰한 3가지 면 모두에서 T1강조FLASH,지방억제T1강조FLASH,T2강조TSE 기법이 True-FISP보다 통계적으로 유의하게 우수하였다(p=0.001).점막층의 명확성에 있어서 가장 우수한 기법은 T1강조FLASH와 지방억제T1강조FLASH이었고(p<0.05),점막하층의 명확성과 점막하층과 근층간의 구분은 T2강조TSE가 가장 우수하였다(p<0.05).전체적인 영상의 질은 T1강조FLASH와 T2강조TSE에서 가장 우수하였다(p<0.05). 결론:자기공명영상은 위벽의 각 층을 구별할 수 있는 우수한 검사로 조직소견과 높은 연관성을 보이며,전체 영상의 질,점막하층의 명확성 및 점막하층과 근층간의 구분이 T2강조TSE에서 가장 우수한다. Purpose: To evaluate normal human gastric wall layers in vitro using magnetic resonance*(MR) imaging, to correlate the results with the histologic findings, and to determine the optimal technique for evaluation of the gastric wall. Materials and Methods: Forty-one normal resected gastric specimens obtained from 25 patients were dissected and placed in a polyethylene tube filled with normal saline. MR imaging with four MR sequences, T1-weighted FLASH*(T1FLASH), fat-saturated T1-weighted FLASH, T2-weighted TSE*(T2TSE), and True-FISP, was performed. The number of gastric wall layers and signal intensity of each layer were determined, and after correlating MR images with the histologic findings, the conspicuity of each layer*(mucosa, submucosa, and muscle), the distinction between each layer, and overall image quality were assessed. results: The gastric wall was shown by TIFLASH to have two (n=6, 14-6%), three (n=31, 75.6%) and four layers (n=4, 9.8%); by fat-saturated TIFLASH to have two (n=6, 14.6%) and three (n=35, 85.4%) ; by T2TSE to have three (n=24, 58.5%), four (n=11, 26.8%), and five (n=6, 14.6%); and by True-FISP to have one (n=2, 4.9%), two (n=8, 19.5%), three (n=23, 56%), four (n=4, 9.8%), and five (n=4, 9.8%) . The signal intensity of each layer at T1FLASH and fat-saturated T1FLASH was high-intermediate from the lumen in two-layer cases, high-low-high/intermediate in three-layer cases, and high-low-high-intermediate in four-layer cases. The signal intensity of each layer at T2TSE was intermediate/high-low-intermediate in three-layer cases, intermediatelow-high-intermediate/low in four-layer cases, and low-high-low-high-low in five-layer cases. Three-layered gastric wall corresponded mostly to mucosa, submucosa, and muscle from the inner to outer layers, respectively. T1FLASH, fat-saturated T1FLASH, and T2TSE were superior to True-FISP in evaluating the gastric wall. T1FLASH and fat-saturated T1FLASH were the best sequences for demonstrating mucosa (p<0.05), and T2TSE was the best for submucosa and the distinction between this and muscle (p<0.05). Both T1FLASH and T2TSE provided the best overall image quality (p<0.05). Conclusion: In-vitro MR imaging is an excellent technique for the evaluation of layers of normal gastric wall. T2TSE is the sequence which best demonstrates the conspicuity of submucosa, the distinction between submucosa and muscle, and overall image quality.