In vitro MRI and Characterization of Rat Mesenchymal Stem Cells Transduced with Ferritin as MR Reporter Gene

신청일,이활,우지수,박은아,김판기,송현복,김회숙 대한자기공명의과학회 2012 Investigative Magnetic Resonance Imaging Vol.16 No.1

Purpose : This study was performed to evaluate the characteristics of rat mesenchymal stem cells (RMSCs) transduced with human ferritin gene and investigate in vitro MRI detectability of ferritin-transduced RMSCs. Materials and Methods: The RMSCs expressing both myc-tagged human ferritin heavy chain subunit (myc-FTH) and green fluorescence protein (GFP) were transduced with lentiviurs. Transduced cells were sorted by GFP expression using a fluorescence-activated cell sorter. Myc-FTH and GFP expression in transduced cells were detected by immunofluorescence staining. The cell proliferative ability and viability were assessed by MTT assay. The RMSC surface markers (CD29+/CD45-) were analyzed by flow cytometry. The intracellular iron amount was measured spectrophotometically and the presence of ferritin-iron accumulation was detected by Prussian blue staining. In vitro magnetic resonance imaging (MRI) study of cell phantoms was done on 9.4 T MR scanner to evaluate the feasibility of imaging the ferritin-transduced RMSCs. Results: The myc-FTH and GFP genes were stably transduced into RMSCs. No significant differences were observed in terms of biologic properties in transduced RMSCs compared with non-transduced RMSCs. Ferritin-transduced RMSCs exhibited increased iron accumulation ability and showed significantly lower T2 relaxation time than non-transduced RMSCs. Conclusion: Ferritin gene as MR reporter gene could be used for non-invasive tracking and visualization of therapeutic mesenchymal stem cells by MRI.

Rat Model of Hindlimb Ischemia Induced via Embolization with Polyvinyl Alcohol and N-Butyl Cyanoacrylate

신청일,김효철,송용섭,Hye Rim Cho,이경분,이활,제환준,정진욱 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.6

Objective: To investigate the feasibility of a rat model on hindlimb ischemia induced by embolization from the administration of polyvinyl alcohol (PVA) particles or N-butyl cyanoacrylate (NBCA). Materials and Methods: Unilateral hindlimb ischemia was induced by embolization with NBCA (n = 4), PVA (n = 4) or surgical excision (n = 4) in a total of 12 Sprague-Dawley rats. On days 0, 7 and 14, the time-of-flight magnetic resonance angiography (TOF-MRA) and enhanced MRI were obtained as scheduled by using a 3T-MR scanner. The clinical ischemic index, volume change and degree of muscle necrosis observed on the enhanced MRI in the ischemic hindlimb were being compared among three groups using the analysis of variance. Vascular patency on TOF-MRA was evaluated and correlated with angiographic findings when using an inter-rater agreement test. Results: There was a technical success rate of 100% for both the embolization and surgery groups. The clinical ischemic index did not significantly differ. On day 7, the ratios of the muscular infarctions were 0.436, 0.173 and 0 at thigh levels and 0.503, 0.337 and 0 at calf levels for the NBCA, PVA and surgery groups, respectively. In addition, the embolization group presented increased volume and then decreased volume on days 7 and 14, respectively. The surgery group presented a gradual volume decrease. Good correlation was shown between the TOF-MRA and angiographic findings (kappa value of 0.795). Conclusion: The examined hindlimb ischemia model using embolization with NBCA and PVA particles in rats is a feasible model for further research, and muscle necrosis was evident as compared with the surgical model.

Feasibility of Commercially Available, Fully Automated Hepatic CT Volumetry for Assessing Both Total and Territorial Liver Volumes in Liver Transplantation

신청일,김세형,임정효,이남준,서경석,이정민,한준구,최병인 대한영상의학회 2013 대한영상의학회지 Vol.68 No.2

Purpose: To assess the feasibility of commercially-available, fully automated hepatic CT volumetry for measuring both total and territorial liver volumes by comparing with interactive manual volumetry and measured ex-vivo liver volume. Materials and Methods: For the assessment of total and territorial liver volume, portal phase CT images of 77 recipients and 107 donors who donated right hemiliver were used. Liver volume was measured using both the fully automated and interactive manual methods with Advanced Liver Analysis® software. The quality of the automated segmentation was graded on a 4-point scale. Grading was performed by two radiologists in consensus. For the cases with excellent-to-good quality, the accuracy of automated volumetry was compared with interactive manual volumetry and measured ex-vivo liver volume which was converted from weight using analysis of variance test and Pearson’s or Spearman correlation test. Processing time for both automated and interactive manual methods was also compared. Results: Excellent-to-good quality of automated segmentation for total liver and right hemiliver was achieved in 57.1% (44/77) and 17.8% (19/107), respectively. For both total and right hemiliver volumes, there were no significant differences among automated, manual, and ex-vivo volumes except between automate volume and manual volume of the total liver (p = 0.011). There were good correlations between automate volume and ex-vivo liver volume (γ= 0.637 for total liver and γ= 0.767 for right hemiliver). Both correlation coefficients were higher than those with manual method. Fully automated volumetry required significantly less time than interactive manual method (total liver: 48.6 sec vs. 53.2 sec, right hemiliver: 182 sec vs. 244.5 sec). Conclusion: Fully automated hepatic CT volumetry is feasible and time-efficient for total liver volume measurement. However, its usefulness for territorial liver volumetry needs to be improved.

영상의학과 전공의에 의한 응급실 컴퓨터단층촬영, 자기공명영상의 야간 예비 판독:얼마나 정확한가?

진광남,제환준,신청일,채지원,전수령,신상도,강영준,나동규 대한응급의학회 2008 대한응급의학회지 Vol.19 No.2

Purpose: At many institutes in Korea, preliminary interpretations of after-hours CT and MR images are performed by radiology residents, with the attending radiologist’s reviewing the interpretations the next day. The purpose of this study was to assess the rate of discrepancy between residents’ interpretations and the final interpretations performed by attending radiologists. Methods: We reviewed the interpretations of 1381 CT and 404 MRI scans that were obtained at the emergency department of our institute over three months. Any discrepancies between the preliminary and final interpretations were categorized as either major or minor discrepancies with a major discrepancy defined as one resulting in a change in diagnosis and treatment plans. We conducted patient follow-up via a retrospective review of the medical records to evaluate the clinical outcomes of the discrepancies. Results: The rate of major discrepancies was 2.5%, and the rate of minor discrepancies was 11.4%. Major discrepancies led to a change in diagnosis or patient treatment plans, but did not lead to any increase in patient morbidity. Conclusion: The discrepancy rate at our institution was relatively insignificant, and patient care at the emergency department was not adversely affected by having radiology residents interpret CT and MRI scans after-hours and the attending radiologist review the interpretations the next morning. Still, further efforts are needed in order to reduce the frequency of major discrepancies.

새로 도입한 응급실 전담 24시간 판독 시스템에 대한 임상의사의 만족도 조사

최영훈,제환준,신청일,송수진,차원철,나동규 대한영상의학회 2008 대한영상의학회지 Vol.58 No.5

목적: 2006년 3월부터 새로이 도입된 응급실 전담 24시간 판독시스템에 대한 임상의사들의 만족도를 평가하고자 설문조사를 하였다. 대상과 방법: 17명의 응급의학과 의사를 대상으로 새로운 응급실 전담 24시간 판독 시스템에 대해 설문조사를 시행하였다. 설문은 크게 다음의 3가지 사항을 묻는 총 10문항으로 이루어졌다. 1) 응급실 전담 영상의학과 전공의 근무 체계; 2) 예비판독 작성 시스템; 3) 전문의에 의한 야간 판독 보조 시스템. 각 문항은 5점 척도를 사용하여 답하도록 하였다. 결과: 두 명의 3년차 영상의학과 전공의가 24시간 교대 근무로 응급실 관련 업무를 전담하는 전공의 근무 체계에 대해서 평균 4.6점(범위 3~5점)으로 높은 만족도를 보였다. ‘야간 및 휴일에 시행된 모든 응급실 CT 및 MR 영상에 대한 실시간 예비판독 작성’시스템에 대한 만족도는 평균 4.8점(범위 4-5점)으로 모든 응답자에서 높은 만족도를 확인하였다. 영상의학과 전문의에 의한 야간 판독 보조 시스템에 대한 필요성의 질문에 대해 평균 4.9점(범위 4-5점)의 높은 점수를 얻었다. 결론: 점차로 증대되고 있는 응급실 내의 영상의학과 서비스에 대한 요구에 맞춰 새로운 응급판독 시스템을 도입하였으며, 본 연구에서는 임상의사를 대상으로 한 설문을 통해 새로 도입된 시스템에 대한 높은 만족도를 확인하였다.

좌내유동맥-관상동맥 우회술 환자에서 동반된 좌측 쇄골하동맥 협착에 대한 중재적 치료

제환준,박재형,신청일,이병진,조영권,정진욱 대한영상의학회 2006 대한영상의학회지 Vol.55 No.2

Purpose: We wanted to evaluate the clinical usefulness of percutaneous transluminal angioplasty (PTA) and stenting of left subclavian artery (LSA) stenosis in the patients with a left internal mammary artery (LIMA)-coronary artery bypass graft. Materials and Methods: From September 1998 to November 2005, significant proximal LSA stenoses were treated with PTA and stenting in 22 patients (15 men and 7 women) who had a prior LIMA-coronary artery bypass graft or who were willing to undergo LIMA-coronary artery bypass grafting. The technical success rates, complications and restenosis during the follow-up period were retrospectively evaluated. Results: Six patients had a prior LIMA bypass graft and 16 patients were treated before their coronary artery bypass surgery. The etiology of the LSA stenosis was atherosclerosis in all patients. Four patients were treated with PTA only, and stents were placed in 18 patients. Technical success was achieved in all patients. An embolism in the proximal LIMA occurred after stenting in one patient, and the LIMA was recanalized with transcatheter thrombolysis. During a mean follow-up of 30 months, only one patient was found to have recurrent LSA stenosis 29 months after stenting and this patient was successfully managed with angioplasty. Conclusion: Endovascular therapy is useful and efficacious for the treatment of LSA stenosis in patients with a LIMA-coronary artery bypass graft. 목적: 좌내유동맥-관상동맥 우회술을 시행 받았거나 받을 예정인 환자에게서 동반된 좌측 쇄골하동맥 협착에 대해 경피경관 혈관성형술과 스텐트 삽입술을 이용한 중재적 치료의 임상적 유용성을 알아보고자 하였다. 대상과 방법: 1998년 9월부터 2005년 11월까지 좌측 쇄골하동맥 협착으로 경피경관 혈관성형술이나 스텐트 삽입술을 시행 받은 환자 중에 좌내유동맥-관상동맥 우회술을 시행 받았거나 받을 예정인 환자 총 22명(남: 여=15:7, 평균 69.3세)을 대상으로 하였다. 쇄골하동맥 협착에 대한 중재적 치료의 기술적 성공률, 합병증 및 재협착 여부를 후향적으로 조사하였다. 결과: 대상환자 중 좌내유동맥-관상동맥 우회술을 시행 받은 환자는 6명, 받을 예정인 환자는 16명이었다. 좌측 쇄골하동맥의 협착원인은 모두 동맥경화성 병변이었다. 혈관성형술은 4예, 스텐트 삽입술은 18예에서 시행되었고 모든 예에서 기술적 성공을 보였다. 스텐트 삽입술 후 1예에서 좌내유동맥의 색전증이 발생하였으나 동맥 내 혈전용해제의 투여로 재개통되었다. 평균 30개월의 추적 관찰 기간 중, 1예에서 스텐트 삽입 29개월 후에 재협착이 발생하였으며 경피경관 혈관성형술로 치료하였다. 나머지 예에서는 심각한 합병증이나 재협착의 증거가 없었다. 결론: 좌내유동맥-관상동맥 우회술 환자에서 동반된 좌측 쇄골하동맥 협착에 대해 경피경관 혈관성형술과 스텐트 삽입술을 이용한 중재적 치료는 유용하고 효과적인 치료방법이다.

Noninvasive Assessment of Hepatic Fibrosis in Patients with Chronic Hepatitis B Viral Infection Using Magnetic Resonance Elastography

이정은,이정민,이경분,윤정희,신청일,한준구,최병인 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.2

Objective: To evaluate the diagnostic performance of magnetic resonance elastography (MRE) for staging hepatic fibrosis in patients with chronic hepatitis B virus (HBV) infection. Materials and Methods: Patients with chronic HBV infection who were suspected of having focal or diffuse liver diseases (n = 195) and living donor candidates (n = 166) underwent MRE as part of the routine liver MRI examination. We measured liver stiffness (LS) values on quantitative shear stiffness maps. The technical success rate of MRE was then determined. Liver cell necroinflammatory activity and fibrosis were assessed using histopathologic examinations as the reference. Areas under the receiver operating characteristic curve (Az) were calculated in order to predict the liver fibrosis stage. Results: The technical success rate of MRE was 92.5% (334/361). The causes of technical failure were poor wave propagation (n = 12), severe respiratory motion (n = 3), or the presence of iron deposits in the liver (n = 12). The mean LS values, as measured by MRE, increased significantly along with an increase in the fibrosis stage (r = 0.901, p < 0.001); however, the mean LS values did not increase significantly along with the degree of necroinflammatory activity. The cutoff values of LS for ≥ F1, ≥ F2, ≥ F3, and F4 were 2.45 kPa, 2.69 kPa, 3.0 kPa, and 3.94 kPa, respectively, and with Az values of 0.987–0.988. Conclusion: MRE has a high technical success rate and excellent diagnostic accuracy for staging hepatic fibrosis in patients with chronic HBV infection.

Clinical Application of Liver MR Imaging in Wilson’s Disease

천정은,김인원,서정기,고재성,이정민,신청일,김우선,연경모 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.6

Objective: To determine whether there is a correlation between liver MR findings and the clinical manifestations and severity of liver dysfunction in patients with Wilson’s disease. Materials and Methods: Two radiologists retrospectively evaluated MR images of the liver in 50 patients with Wilson’s disease. The Institutional Review Board approved this retrospective study and informed consent was waived. MR images were evaluated with a focus on hepatic contour abnormalities and the presence of intrahepatic nodules. By using Fisher’s exact test, MR findings were compared with clinical presentations (neurological and non-neurological) and hepatic dysfunction, which was categorized by the Child-Pugh classification system (A, B and C). Follow-up MR images were available for 17 patients. Results: Contour abnormalities of the liver and intrahepatic nodules were observed in 31 patients (62%) and 25 patients (50%), respectively. Each MR finding showed a statistically significant difference (p < 0.05) among the three groups of Child-Pugh classifications (A, n = 36; B, n = 5; C, n = 9), except for splenomegaly (p = 0.243). The mean age of the patients with positive MR findings was higher than that of patients with negative MR findings. For patients with Child-Pugh class A (n = 36) with neurological presentation, intrahepatic nodules, surface nodularity, and gallbladder fossa widening were more common. Intrahepatic nodules were improved (n = 8, 47%), stationary (n = 5, 29%), or aggravated (n = 4, 24%) on follow-up MR images. Conclusion: MR imaging demonstrates the contour abnormalities and parenchymal nodules of the liver in more than half of the patients with Wilson’s disease, which correlates with the severity of hepatic dysfunction and clinical manifestations. Objective: To determine whether there is a correlation between liver MR findings and the clinical manifestations and severity of liver dysfunction in patients with Wilson’s disease. Materials and Methods: Two radiologists retrospectively evaluated MR images of the liver in 50 patients with Wilson’s disease. The Institutional Review Board approved this retrospective study and informed consent was waived. MR images were evaluated with a focus on hepatic contour abnormalities and the presence of intrahepatic nodules. By using Fisher’s exact test, MR findings were compared with clinical presentations (neurological and non-neurological) and hepatic dysfunction, which was categorized by the Child-Pugh classification system (A, B and C). Follow-up MR images were available for 17 patients. Results: Contour abnormalities of the liver and intrahepatic nodules were observed in 31 patients (62%) and 25 patients (50%), respectively. Each MR finding showed a statistically significant difference (p < 0.05) among the three groups of Child-Pugh classifications (A, n = 36; B, n = 5; C, n = 9), except for splenomegaly (p = 0.243). The mean age of the patients with positive MR findings was higher than that of patients with negative MR findings. For patients with Child-Pugh class A (n = 36) with neurological presentation, intrahepatic nodules, surface nodularity, and gallbladder fossa widening were more common. Intrahepatic nodules were improved (n = 8, 47%), stationary (n = 5, 29%), or aggravated (n = 4, 24%) on follow-up MR images. Conclusion: MR imaging demonstrates the contour abnormalities and parenchymal nodules of the liver in more than half of the patients with Wilson’s disease, which correlates with the severity of hepatic dysfunction and clinical manifestations.

CT Findings of Gallbladder Metastases: Emphasis on Differences According to Primary Tumors

최원석,김세형,이은선,이경분,윤원재,신청일,한준구 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.3

Objective: To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumorsMaterials and Methods: Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. Results: The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. Conclusion: Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.

Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report

민사홍,양한광,이창민,정헌진,이경규,서윤석,신청일,김형호 대한위암학회 2013 Journal of gastric cancer Vol.13 No.4

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwentsurgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computedtomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.