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신생아 담즙 정체증의 영상 진단에 있어서 자기공명담관조영술의 유용성: $^{99m}Tc$ DISIDA scan과의 비교
김명준,윤춘식,이종두,김시연,Kim, Myeong-Jun,Yun, Chun-Sik,Lee, Jong-Du,Kim, Si-Yeon 대한영상의학회 2003 대한영상의학회지 Vol.49 No.4
목적: 신생아 담즙 정체증 환자에서 초음파검사 다음으로 시행할 수 있는 이차 영상 진단법으로서 자기공명담관조영술의 진단적 가치를 평가하기 위하여 자기공명담관조영술과 간담도스캔을 비교하였다. 대상과 방법: 포합성 고빌리루빈혈증이 의심되어 초음파검사, 간담도스캔 및 자기공명담관조영술을 모두 시행한 22명의 환자(연령분포 23-103일; 평균 57일)를 대상으로 후향적 평가를 시행하였다. 15명은 수술적 담관조영술과 간생검에 의해 담도 폐쇄증으로 진단된 환자였고, 6명은 영상 소견 및 임상 양상을 종합하여 신생아 간염으로 진단한 환자였으며 나머지 1명은 수술적 담관조영술과 간생검을 실시하여 신생아 간염으로 진단하였다. 간담도스캔과 자기공명담관조영술에 대하여 각각 두 명의 판독의가 임상 정보 및 최종 진단명을 모르는 상태에서 독립적으로 영상을 분석하였고 각 영상 검사의 진단적 정확성과 판독자간의 일치도를 조사하였다. 결과: 간담도스캔에서 담도 폐쇄증을 신생아 간염으로 오인한 경우가 8명, 신생아 간염을 담도폐쇄증으로 오인한 경우가 4명이었다. 자기공명담관조영술에서 담도 폐쇄증을 신생아 간염으로 오인한 경우 및 신생아 간염을 담도 폐쇄증으로 오인한 경우는 각각 2명씩이었다. 간담도스캔의 민감도, 특이도, 정확도, 양성예측도 및 음성예측도는 48%, 47%, 48%, 66%, 30%였고, 자기공명담관조영술은 각각 90%, 71%, 84%, 87%, 81%였다. 판독자간의 일치도는 간담도스캔이 0.62, 자기공명담관조영술이 0.85였다. Purpose: To evaluate the diagnostic validity of MR cholangiography as a second-line imaging tool following sonography in the evaluation of neonatal cholestasis, we compared MR cholangiography with $^{99m}Tc$ DISIDA scan. Materials and Methods: We retrospectively evaluated sonography, $^{99m}Tc$ DISIDA scan and MR cholangiography in twenty-two neonates and infants (age range, 23-103 days; mean age, 57 days) presenting with conjugated hyperbilirubinemia. Of the 22 patients, 15 were diagnosed as biliary atresia by operative cholangiography and liver biopsy and six as neonatal hepatitis by imaging finding and clinical data. Remaining one patient was diagnosed as neonatal hepatitis by operative cholangiography and liver biopsy. Two independent observers for each study were assigned to review the images of $^{99m}Tc$ DISIDA scan and MR cholangiography without giving the final diagnosis or other clinical data. Diagnostic accuracy and interobserver variability for each study were evaluated. Results: On $^{99m}Tc$ DISIDA scan, biliary atresia was mistaken for neonatal hepatitis in eight patients and vice versa in four patients. On MR cholangiography, it was mistaken biliary atresia as neonatal hepatitis and vice versa in each two patients. Sensitivity, specificity, accuracy, positive and negative predictive values of $^{99m}Tc$ DISIDA scan were 48%, 47%, 48%, 66% and 30%, respectively, and those of MR cholangiography were 90%, 71%, 84%, 87% and 81%, respectively. Interobserver variabilities for $^{99m}Tc$ DISIDA scan and MR cholangiography were 0.62 and 0.85, respectively. Conclusion: In the evaluation of patients with neonatal cholestasis, it would be advisable to use MR cholangiography, having superior diagnostic accuracy to $^{99m}Tc$ DISIDA scan, as a second-line imaging tool following sonography.
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유병성,윤춘식,김현아,장윤희,Yoo, Byeong Seong,Yun, Chun Sik,Kim, Hyun Ah,Chang, Yun Hee 한국식품조리과학회 2017 한국식품조리과학회지 Vol.33 No.1
Purpose: This study developed sourdough bread according to consumers' preferencesby shortening the sourdough fermentation process time through addition of makgeolli to sourdough. Methods: Fermentation time was measured by adding makgeolli and water to wheat flour. Results: Fermentation time was shorter than that of starter made with only water and flour, with 5 hours of primary fermentation and 3 hours of secondary fermentation. The optimum mixing ratio was 400 g of flour, 192 mL of water, and 48 mL of makgeolli. An increase in makgeolli sourdough content decreased crude protein and moisture contents of white bread. Crude fat and ash contents increased, and volume of bread was decreased as sourdough increased. The height of bread prepared with makgeolli sourdough was lower than that of bread without makgeolli sourdough. According to the results of the texture measurement, hardness, gumminess, and chewiness of sourdough group were lower as the addition of sourdough increased. Addition of makgeolli sourdough to white bread resulted in decreased lightness, but increased yellowness of white bread. Preparation of white bread with addition of sourdough improved taste and flavor compared to bread prepared only with wheat flour. Conclusion: The highest sensory preference was observed for white bread prepared whit 5 g of sourdough.
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