갑상선 결절성 비후의 악성 전환: 증례 보고

인현신,김동욱,윤혜경 대한영상의학회 2007 대한영상의학회지 Vol.57 No.6

Thyroid carcinogenesis is traditionally thought to originate 'de novo'. However, it is debatable whether a malignant transformation can possibly arise from a benign thyroid nodule, as suggested for the malignant transformation of a thyroid adenoma. To the best of our knowledge, no studies have been performed addressing the malignant transformation of nodular hyperplasia in the thyroid gland. Here, we report a case of nodular hyperplasia with focally malignant degeneration. 갑상선암은 처음부터 악성 갑상선 세포가 자라는 것으로 알려졌으며 양성 갑상선 결절의 악성 전환에 대해서는 논란이 있는데, 저자들은 최근 갑상선의 결절성 비후에서 국소적으로 악성 전환된 1예를 경험하였기에 보고하는 바이다.

장경 1 cm 이하 갑상선 결절의 초음파 유도하 세침흡인생검

김상수,인현신,은충기 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.1

Purpose: The aim of this study is to determine the efficacy of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules that are equal to or less than 1 cm at the maximum diameter. Materials and Methods: The US-FNABs performed on thyroid nodules from March to August 2009 were included in this study. We retrospectively evaluated the cytopathologic results as well as any complications associated with the procedure. Results: Of the 241 thyroid nodules (range: 0.1 - 1.0 cm, mean size: 5.8 mm) in 184 patients (female: male = 164:20, mean age: 49.0 years, age range: 18 - 77 years old), the incidence of an inadequate sample was 14.1% (34/241) for the US-FNABs. Eighty six nodules were surgically removed in 62 patients, of which 15 were confirmed to be benign nodules and 71 were confirmed to be malignant nodules. The number of true positive, false positive, true negative and false negative results for US-FNAB were 59, 0, 10 and 3%, respectively, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 95.2%, 100%, 100%, 76.9% and 95.8%, respectively. All the false negative cases were less than 3 mm at the maximal diameter. There were no serious complications in all the patients. Conclusion: US-FNAB was effective for the cases of thyroid nodule under 1 cm at the maximal diameter. However, a false negative result of US-FNAB should be considered for the cases of very small nodules that are less than 3 mm at the maximal diameter. 목적: 장경 1 cm 이하인 갑상선 결절에 대한 초음파 유도하 세침흡인생검의 효율성을 알아 보고자 하였다. 대상 및 방법: 2009년 3월부터 8월까지 갑상선 결절의세침흡인생검을 받은 환자 중 결절의 장경이 1 cm 이하인결절을 대상으로 세포진단결과와 수술 후 확진된 병리결과를 비교 분석하고 세침흡인생검에 따른 합병증 발생을조사하였다. 결과: 총 184명의 환자에서 (여자 : 남자 = 164 : 20,평균 연령 : 49세, 범위 : 18-77세) 장경 1 cm 이하인 갑상선 결절 241개 중에서 (평균 : 0.58 cm, 범위 : 0.1 -1.0 cm) 첫 번째 세침흡인생검에서 불충분한 검체로 확인된 경우가 14.1% (34개) 였다. 62명의 환자가 수술을 받았고 86개의 결절이 조직학적으로 확진되었는데, 71개의결절은 갑상선 유두암이었고 15개는 양성이었다. 86개의결절에 대한 첫 번째 세침흡인생검은 진양성 59, 위양성0, 진음성 10, 위음성 3을 보였으며, 민감도 95.2%, 특이도 100%, 양성예측도 100%, 음성예측도 76.9% 및 정확성 95.8% 이었다. 3건의 위음성의 경우 모두 장경 3 mm 미만의 결절이었고 모든 환자에서 중대한 합병증은 관찰되지 않았다. 결론: 장경 1 cm 이하 갑상선 결절에 대한 세침흡인생검은 효율적이다. 하지만 장경이 3 mm 이하인 미세 갑상선유두암에 있어서는 위음성의 결과가 초래될 수도 있으므로 첫 번째 세침흡인생검에서 음성의 결과를 보이더라도추가적인 세침흡인생검을 시행하는 등의 주의가 필요하다.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

이영훈,김동욱,인현신,박지성,김상효,엄재욱,김보미,이은주,노명호 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.5

Objective: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. Materials and Methods: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: “malignant,” “suspicious for malignancy,” “borderline,” “probably benign,” and “benign”. We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. Results: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n =82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). Conclusion: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

The Significance of Immunohistochemical Staining, Including that for Glucose Transporter Protein Isoform 1, as Related to the Clinical and Angiographic Features of Adult Soft-Tissue Hemangioma and Arteriovenous Malformation in the Head and Neck

이하영,김선미,인현신,조경자,차은영,황정은,강신광,남순열,김상윤,이봉재,이정현,서대철,최진우 대한영상의학회 2009 대한영상의학회지 Vol.60 No.2

Purpose: Glucose transporter protein isoform 1 (GLUT1) has been introduced to diagnose the hemangiomas of infancy. We investigated the usefulness of several immunohistochemical markers, including GLUT1, as related with the clinical and radiologic findings for making the diagnosis of adult subcutaneous vascular lesions in the head and neck. Materials and Methods: The 24 patients who underwent operations for soft tissue vascular lesion during the previous 7 years were included in this study. We analyzed the angiographic data, the clinical data and the immunohistochemical study results, including the GLUT1, S-100 protein and Movat pentichrome staining. Results: Twenty-two patients were confirmed to have arteriovenous malformation (AVM) and two hemangiomas, respectively. The number of lesions with positive Movat pentichrome, S-100 and GLUT1 staining in the patients with AVM and those patients with hemangioma were 22/22, 20/22 and 0/22, and 0/2, 0/2 and 0/2, respectively. For the 22 patients with AVMs, eight had a soft tissue vascular lesion at birth, 13 had cutaneous change and 15 had a change of the size of the lesion. For the 2 patients with one hemangioma each, neither patient had a soft tissue vascular lesion at birth, and both patients had cutaneous change and a change of the size of the lesion. The angiograms revealed a focal hypervascular mass (19/24) or diffuse staining (5/24) without showing significant features for making the definitive differential diagnosis. Conclusion: Our study revealed that none of the patients with AVM or hemangioma had GLUT1 positivity, and an arteriovenous malformation was more common than the adult-type hemangioma.

결핵성 파괴폐 환자의 비행기 여행 중 발생한 대뇌 공기 색전증: 1예

정현석,정해웅,인현신 대한영상의학회 2011 대한영상의학회지 Vol.65 No.2

A cerebral air embolism is a rare cause of stroke, but may occur in patients undergoing invasive cardiac and pulmonary procedures, as well as in divers suffering pulmonary barotrauma from rapid ascent. A cerebral air embolism due to other causes, especially a change of air pressure from air travel, is particularly rare. Here, we report a case of cerebral air embolism during commercial air travel in a patient with an tuberculous-destroyed lung. 대뇌 공기 색전증은 뇌경색의 드문 원인이다. 이러한 대뇌 공기 색전증의 흔한 원인은 심장과 폐에 대한 침습적 시술, 스쿠버 다이빙 중 빠른 해수면 상승에 의한 폐 압력 손상 등이 있다. 하지만 비행기 여행 등의 기압 변화에 의한 대뇌 공기 색전증 발생은 매우 드물며, 현재까지 7개의 증례가 보고 되었다. 이에 저자들은 결핵성 파괴폐 환자에서 비행기 여행 중 발생한 대뇌 공기 색전증을 경험하여, 이에 대한 증례 보고를 하는 바이다.

Magnetic Resonance Finding of Acute Marchiafava-Bignami Disease with Diffuse Involvement: A Case Report

허영진,정해웅,인현신 대한영상의학회 2011 대한영상의학회지 Vol.65 No.5

Marchiafava-Bignami disease (MBD) is a rare toxic disorder strongly associated with chronic alcoholism (1-3, 6, 7). It is characterized by progressive demyelination and necrosis of the corpus callosum. The process may extend to neighboring white matter and subcortical regions. We report a case of MBD in which fluid-attenuated inversion recovery and diffusion-weighted imaging revealed symmetrical hyperintense lesions with diffuse involvement of the corpus callosum, white matter, corticospinal tract, internal capsule, and middle cerebellar peduncle (3, 4, 8).

신경피부흑색증: 증례 보고

서윤내,정해웅,인현신 대한영상의학회 2011 대한영상의학회지 Vol.65 No.6

Neurocutaneous melanosis is a rare disorder characterized by the presence of a large or multiple congenital melanocytic nevus with proliferation of melanocytes in the central nervous system. The prognosis of neurocutaneous melanosis is extremely poor and its diagnostic approach requires understanding its brain magnetic resonance imaging findings. We report a patient with asymptomatic neurocutaneous melanosis and its radiologic findings. 신경피부흑색증(neurocutaneous melanosis)은 여러 개 혹은 크기가 큰 선천성 멜라닌세포모반(congenital melanocytic nevus)과 중추신경계에 멜라닌세포의 증식을 특징으로 하는 신경피부증후군(neurocutaneous syndrome)이다. 신경피부흑색증은 드물게 발생하지만 예후가 나쁘기 때문에 진단적 접근을 위한 자기공명영상(MRI) 소견에 대한 이해가 필요하다. 이에 본 저자들은 영상학적 소견을 중심으로 신경피부흑색증 1예를 보고하고자 한다.

Diagnosis of Vertebral Artery Ostial Stenosis on Contrast-Enhanced MR Angiography: Usefulness of a Thin-Slab MIP Technique

김선미,이덕희,최진우,최병세,인현신 대한자기공명의과학회 2011 Investigative Magnetic Resonance Imaging Vol.15 No.1

It is a well-known clinical fact that contrast-enhanced magnetic resonance angiography exaggerates vertebral arterial ostial stenosis and sometimes shows pseudostenosis. Considering the clinical significance of a lesion in the posterior circulation ischemia, the importance of an accurate imaging diagnosis of ostial stenosis should not be underestimated. We were able to differentiate pseudostenosis of the ostium from true stenosis using thin-slab maximum-intensity-projection(MIP)images which are thought to be helpful for minimizing standard full thickness MIP images.

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

정선영,이덕희,최진우,최병세,인현신,김선미,최충곤,김상준,서대철 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.2

Objective: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. Materials and Methods: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. Results: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. Conclusion: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval. Objective: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. Materials and Methods: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. Results: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. Conclusion: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.