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특발성 폐섬유증에서 발견된 폐결절의 악성여부 감별에서 F-18 FDG PET의 유용성
김범산 ( Bom Sahn Kim ),강원준 ( Won Jun Kang ),이동수 ( Dong Soo Lee ),정준기 ( June Key Chung ),이명철 ( Myung Chul Lee ) 대한핵의학회 2006 핵의학 분자영상 Vol.40 No.3
목적: 특발성 폐섬유증(Idiopathic pulmonary fibrosis: IPF)에서 폐암의 발생빈도가 정상인에 비하여 증가되어 있음이 알려져 있다. IPF 환자의 흉부전산화단층촬영(chest CT)에서 폐 결절이 관찰되는 경우 폐암의 발생과 자체 IPF자체의 결절을 감별하기 어렵다. 이 연구에서는 IPF 환자의 chest CT에서 관찰된 결절의 악성 여부를 FDG PET을 이용해 분석하였다. 대상 및 방법: IPF로 진단된 환자 중, chest CT에서 악성 결절이 의심되어 FDG PET을 시행한 16명을 대상으로 하였다. 총 16명 (남: 14, 여: 2, 나이: 67.53±9.83세)의 환자에서 관찰된 28개의 결절에 대하여 FDG PET과 CT소견을 분석하였다. 대상 환자 중 2명은 소세포암과 성문하암으로 치료 받은 병력이 있었으며, 나머지 환자는 악성종양의 기왕력이 없었다. 결절의 악성도 여부는 조직검사와 CT 추적검사로 판정하였다. 결과: 10개의 결절은 폐암으로 진단되었고, 18개의 결절은 양성 결절로 판정되었다(조직병리검사: 6예, chest CT 추적검사: 22예). FDG PET의 예민도는 100%이었으며 특이도는 94.4%이었다. 크기와 형태 및 크기 변화 등을 참고한 CT의 예민도는 70%이었고, 특이도는 44.4%이었다. 악성 결절의 maxSUV는 7.68±3.96, 양성 결절은 1.22±0.65이었다(p<0.001). 폐섬유증부위에서 측정한 maxSUV는 1.80±0.43로써 악성 결절보다 낮은 값이었으며, 양성 결절보다는 높은 값이었다(p<0.001; p<0.001). CT에서 측정한 악성 결절의 크기는 23.95±10.15 mm, 양성결절은 10.83±5.23 mm이었다(p<0.02). 결론: FDG PET은 IPF 환자의 CT에서 발견된 폐 결절을 감별하는데 도움이 되었다. Purpose: Incidence of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is known to be higher than that in general population. However, it is difficult to discriminate pulmonary nodule in patients with IPF, because underlying IPF can be expressed as lung nodules. We evaluated the diagnostic performance of FDG PET in discriminating lung nodule in patients with IPF. Methods: We retrospectively reviewed 28 lung nodules in 16 subjects (age; 67.53±9.83, M:F=14:2). Two patients had previous history of malignant cancer (small cell lung cancer and subglottic cancer). The diagnostic criteria on chest CT were size, morphology and serial changes of size. FDG PET was visually interpreted, and maximal SUV was calculated for quantitative analysis. Results: From 28 nodules, 18 nodules were interpreted as benign nodules, 10 nodules as malignant nodules by histopahthology or follow-up chest CT. The sensitivity and specificity of FDG PET were 100% and 94.4%, while those of CT were 70.0% and 44.4%, respectively. Malignant nodule was higher maxSUV than that of benign lung nodules (7.68±3.96 vs. 1.22±0.65, p<0.001). Inflammatory lesion in underlying IPF was significantly lower maxSUV than that of malignant nodules (1.80±0.43, p<0.001). The size of malignant and benign nodule were 23.95±10.15 mm and 10.83 ±5.23 mm (p<0.01). Conclusion: FDG PET showed superior diagnostic performance to chest CT in differentiating lung nodules in patients with underlying IPF. FDG PET could be used to evaluate suspicious malignant lung nodule detected by chest in patients with IPF. (Nucl Med Mol Imaging 2006;40(3):163-168)
김영환,윤혜전,김예미,김범산 한국유방암학회 2015 Journal of breast cancer Vol.18 No.2
Purpose: This study assessed the axillary lymph node (ALN)-toprimary tumor maximum standard uptake value (SUVmax) ratio (ALN/T SUV ratio) in invasive ductal breast cancer (IDC) on preoperative 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) to determine the effectiveness in predicting recurrence-free survival (RFS). Methods: One hundred nineteen IDC patients (mean age, 50.5±10.5 years) with pathologically proven ALN involvement without distant metastasis and preoperative FDG PET/CT were enrolled in the study. SUVmax values of the ALN and primary tumor were obtained on FDG PET/CT, and ALN/T SUV ratio was calculated. Several factors were evaluated for their effectiveness in predicting RFS. These included several parameters on FDG PET/CT as well as several clinicopathological parameters: pathologic tumor/ node stage; nuclear and histological grade; hormonal state; status with respect to human epidermal growth factor receptor 2, mindbomb E3 ubiquitin protein ligase 1 (MIB-1), and p53; primary tumor size; and ALN size. Results: Among 119 patients with breast cancer, 17 patients (14.3%) experienced relapse during follow-up (mean follow-up, 28.4 months). The ALN/T SUV ratio of the group with disease recurrence was higher than that of the group without recurrence (0.97±1.60 and 0.45±0.40, respectively, p=0.005). Univariate analysis showed that the primary tumor SUVmax, ALN SUVmax, ALN/T SUV ratio, ALN status, nuclear and histological grade, estrogen receptor (ER) status, and MIB-1 status were predictors for RFS. Among these variables, ALN/T SUV ratio with hazard ratio of 4.20 (95% confidence interval [CI], 1.74–10.13) and ER status with hazard ratio of 4.33 (95% CI, 1.06–17.71) were predictors for RFS according to multivariate analysis (p=0.002 and p=0.042, respectively). Conclusion: Our study demonstrated that ALN/T SUV ratio together with ER status was an independent factor for predicting relapse in IDC with metastatic ALN. ALN/T SUV ratio on preoperative FDG PET/CT may be a useful marker for selecting IDC patients that need adjunct treatment to prevent recurrence.
윤영신,강희진,김정은,김범산,박기덕,최경규,정지향 대한치매학회 2010 Dementia and Neurocognitive Disorders Vol.9 No.2
A 66-yr-old woman presented with progressive cognitive decline and mild hyperkinetic motor symptoms. Neuropsychological evaluation revealed impairment of memory and frontal executive functions with normal activities of daily living, indicating a mild cognitive impairment. Brain imaging showed extensive calcification involving bilateral basal ganglia, thalamus, occipital cortex and cerebellum consistent with Fahr disease. FDG-PET showed diffuse glucose hypometabolism in bilateral fronto-temporo-parietal cortices, suggesting the disruption of frontal subcortical circuit to be probably associated with the cognitive impairment of the patient.