Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction

심동재,권동일,한기창,김육,고기영,신지훈,고흥규,김진형,김종우,윤현기,성규보 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.4

Objective: To investigate the outcomes of percutaneous metallic stent placements in patients with malignant biliary hilar obstruction (MBHO). Materials and Methods: From January 2007 to December 2014, 415 patients (mean age, 65 years; 261 men [62.8%]) with MBHO were retrospectively studied. All the patients underwent unilateral or bilateral stenting in a T, Y, or crisscross configuration utilizing covered or uncovered stents. The clinical outcomes evaluated were technical and clinical success, complications, overall survival rates, and stent occlusion-free survival. Results: A total of 784 stents were successfully placed in 415 patients. Fifty-five patients had complications. These complications included hemobilia (n = 19), cholangitis (n = 13), cholecystitis (n = 11), bilomas (n = 10), peritonitis (n = 1), and hepatic vein-biliary fistula (n = 1). Clinical success was achieved in 370 patients (89.1%). Ninety-seven patients were lost to follow-up. Stent dysfunction due to tumor ingrowth (n = 107), sludge incrustation (n = 44), and other causes (n = 3) occurred in 154 of 318 patients. The median overall survival and the stent occlusion-free survival were 212 days (95% confidence interval [CI], 186−237 days) and 141 days (95% CI, 126−156 days), respectively. The stent type and its configuration did not affect technical success, complications, successful internal drainage, overall survival, or stent occlusion-free survival. Conclusion: Percutaneous stent placement may be safe and effective for internal drainage in patients with MBHO. Furthermore, stent type and configuration may not significantly affect clinical outcomes.

확산강조영상을 이용한 고혈압성 뇌병증의 발병 기전에 관한 연구

심동재,임명관,김형진,조영국,서창해 대한영상의학회 2001 대한영상의학회지 Vol.45 No.1

목적: 고혈압성 뇌병증에서 나타나는 부종성 병변의 생성기전을 확산강조영상을 통해 알아보고자 하였다 대상과 방법: 14명의 고혈압성 뇌병증 환자에서 모두 17회의 MR을 시행하였다. 이중 8명은 본태성 고혈압 환자였으며, 임신중독성 자간증에 의한 것이 3명 사이클로스포린에 의해 유도된 것이 3명이었다 이 환자들의 T2강조영상에서 보인 뇌부종병변에 대해 확산강조영상에서 신호 강도의 변화와 정상백질 부위와의 현성 확산 계수(ADC: apparent diffusion coefficient)의 타이를 비교하였다. 같은 방법으로 추적 MR검사에서 변화를 관찰하였다. 결과: T2강조영상에서 14명의 환자 모두후두염의 뇌백질에 고신호 강도의 부종소견을 보였고 확산강조영상에서는. 3명의 본태성 고혈압 환자의 약간 높은 신호강도를 제외한 다른 환자에서 모두 동등신호강도를 보였다. 본태성 고혈압 환자의 부종부위의 백질의 평균 ADC값은 1.21 $\pm$ 0.34, 자간-전자간 환자에서는 1.08$\pm$0.28 사이클로스포린 유도 고혈압에서는 1.28$\pm$0.22 mm$^2$/ms로 나타났으며 이때 정상 백질의 ADC값은 각각 0 77$\pm$0.25. 0.71$\pm$0.22, 0.68$\pm$0.27 mm$^2$/ms였다. 부종부위에서의 ADC값은 정상백질부위보다 모두 통계적으로 유의한 증가를 보였다(f(0.05) . 각 군간의 부종부위 ADC값은 통계적으로 유의한 타이를 보이지 않았다 (p〉0.05). 3예의 추적검사에서 부종성 병변은 후유증을 남기지 않고 회복된 소견을 보였고 확산강조영상이나 ADC값이 모두 정상백질과 비슷하게 나타났다. 결론: 고혈압성 뇌병증의 급성기에 나타나는 부종은 세포독성(cytotoxic)보다 혈관성(vaso-genic) 원인에 의해 나타난다. Purpose: To investigate the nature of edematous lesions seen on MR images during acute episodes of hypertensive encephalopathy(HTE) with particular attention to the findings of diffusion-weighted imaging (DWI) . Materials and Methods: A total of 17 MR examinations in fourteen patients with hypertensive encephalopathy were performed, The diagnoses were idiopathic HTE in eight cases, eclampsia in three, and cyclosporin-inducted HTE in three. The apparent diffusion coefficients(ADCs) of edematous lesions and normal white matter revealed by DWI were assessed and compared, and the changes observed at follow-up MR imaging were analysed. Results: DWI obtained within one week of the appearance of acute neurological symptoms revealed the ede-ma as iso-intense in all patients with eclampsia and cyclosporin-induced HTE, and in five of eight patients with idiopathic HTE. In the other three patients with idiopathic HTE, DWI demonstrated slightly hyperintense erie-ma. The ADCs of edematous lesion in patients with idiopathic HTE, eclampsia and cyclosporin-induced HTE were 1.21 $\pm$0.34, 1.08$\pm$0.28, and 1.28$\pm$0.22 mm$^2$/ms, respectively, while for normal white matter the corre-sponding figures were 0.77$\pm$0.25,0.71 $\pm$0.22, and 0.68$\pm$0.27mm$^2$/ms The differences in ADCs between erie-ma and normal white matter were thus significantly different between the three patient groups (p < 0.05),while the ADCs o( edematous lesions showed no sisgnificant variation between these groups (p< 0.05). follow-up MRI revealed that in three cases, edematous lesions were reversible and there were no residual signal changes. Conclusion: Vasogenic rather than cytotoxic edema is present during the acute stage of HTE.

Critical Role of Clinical Suspicion in the Diagnosis of Arterio-Ureteral Fistula

김도영,심동재 대한영상의학회 2021 대한영상의학회지 Vol.82 No.3

Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report

이은별,심동재,김도영,이정휘 대한영상의학회 2021 대한영상의학회지 Vol.82 No.3

Systemic-to-pulmonary artery fistulas are rare. This condition may be congenital, post-traumatic, or post-inflammatory and can cause infection, hemorrhage, or pulmonary hypertension. Here, we report a case of an intercostal-to-pulmonary artery fistula, incidentally detected during the evaluation of dyspnea in a 67-year-old female. Retrograde transcatheter coil embolization in a dilated draining pulmonary artery was initially attempted. However, another draining pulmonary artery developed after 5 months. The intercostal arteries or systemic feeders were successfully embolized through a transarterial access. At the 10-month follow-up, the abnormally dilated vessels had regressed, and dyspnea had improved. Sequential or simultaneous retro- and antegrade transcatheter embolization may successfully treat pleural arterio-arterial fistulas.

Common Peroneal Neuropathy With Anterior Tibial Artery Occlusion: A Case Report

전성수,김다예,심동재,김민욱 대한재활의학회 2017 Annals of Rehabilitation Medicine Vol.41 No.4

Peroneal neuropathy is a common mononeuropathy of the lower limb. Some studies have reported cases of peroneal neuropathy after vascular surgery or intervention. However, no cases of peroneal neuropathy with occlusion of a single peripheral artery have been previously reported. A 73-year-old man was referred with a 3-week history of left-sided foot drop. He had a history of valvular heart disease and arrhythmia, and had previously been treated with percutaneous coronary intervention. Computed tomography angiogram of the lower extremity showed proximal occlusion of the left anterior tibial artery. An electrodiagnostic study confirmed left common peroneal neuropathy. After diagnosis, anticoagulation therapy was started and he received physical therapy.

급성소장폐쇄시 장경색의 진단에 있어서 조영증강 나선식 CT의 유용성

강영혜,김원홍,전용선,심동재,조순구,이창근,최선근 대한영상의학회 2004 대한영상의학회지 Vol.51 No.6

Purpose: We wished to evaluate the usefulness of helical CT for the diagnosis of strangulation of the dilated small bowels. Materials and Methods: The CT scans of 31 patients with small bowel obstruction from various causes were reviewed retrospectively. Thirteen of these patients were confirmed as small bowel strangulation by surgery and pathology. Fourteen patients underwent surgery, but they had no strangulation. Three patients were reduced by using a nasogastric tube and one infant with intussusception was reduced by air reduction. The following CT findings of strangulation were evaluated: reduced bowel wall enhancement by visual assessment and measuring the HU, ascites, thickening of bowel wall, abnormal mesenteric vessel location and whirlpool appearance, and mesenteric venous engorgement. For the precise evaluation of reduced bowel wall enhancement, the HUs were measured by 1 mm2 of ROI, and the differences of HUs between the well enhanced bowel and poorly enhanced bowel were compared. Results: For the diagnosis of strangulation, measurement of HU of the bowel wall could improve the sensitivity from 69% to 100%. The specificity of both methods, by visual assessment and measurement of HU, was 94%. Ascites had a sensitivity of 69% and specificity of 44%. Thickening of bowel wall had a sensitivity of 38% and specificity of 78%. Abnormal mesenteric vessel location and whirlpool appearance had a sensitivity of 38% and specificity of 83%. Mesenteric venous engorgement had a sensitivity of 31% and specificity of 72%. Conclusion: Measurement of HU of the bowel wall after contrast enhancement can be a useful method in the differential diagnosis between the strangulated and non-strangulated bowels in patients with small bowel obstruction. 목적: 소장폐쇄와 동반된 소장경색 시 조영증강 나선식 CT에서 보일 수 있는 경색된 장의 조 영증강 감소가 경색의 진단에 유용함을 밝히고 동반된 징후(조영증강 전의 고음영, 장벽의 두 께변화, 장간막액 증가 또는 복수, 장간막동정맥 울혈)의 유용성에 대해 알아보고자 한다. 대상과 방법: 단순 복부촬영에서 급성소장폐쇄로 진단된 31명의 환자에서 소장경색을 진단하기 위하여 조영증강 나선식 CT를 시행하였다. 수술로 확인된 소장경색 환자 13명과 수술하여 경 색없는 단순 폐쇄만 있었던 14명 및 수술하지 않고 대증요법으로 호전된 환자 4명을 경색군 13명과 단순폐쇄군 18명으로 나누어 복부 CT를 후향적으로 분석하였다. 경색이 의심되는 장 의 조영증강을 평가하기 위해 시각적 비교와 1 mm2의 관심영역을 이용한 장벽의 Hounsfield unit(HU)을 측정하였고 장간막동정맥의 위치변화 혹은 장간막의 whirlpool 모양, 소장벽의 두 께 증가, 복수, 장간막 정맥 울혈을 수술 및 병리소견과 비교하였다. 결과: 소장폐쇄 시 경색된 장의 진단에서 주관적인 시각적 비교로 측정한 소장 벽의 감소된 조 영증강은 69%의 민감도와 94%의 특이도를 보였고 객관적인 HU을 이용하여 조영증강의 감 소 여부를 비교하면 민감도가 100%로 증가하였고 특이도는 94%로 변화가 없었다. 복수는 경 색군에서 9예(69%)와 단순폐쇄군에서 10예(56%), 소장벽의 두께 증가는 경색군에서 5예 (38%), 단순폐쇄군에서 4예(22%), 장간막동정맥의 위치변화 혹은 장간막의 소용돌이 모양은 경색군에서 5예(38%), 단순폐쇄군에서 3예(17%)가 관찰되었고, 장간막정맥 울혈은 경색군에 서 4예(31%)와 단순폐쇄군에서 5예(28%)가 관찰되었다. 결론: 소장폐쇄에서 나선식 CT를 이용하여 경색된 장벽의 HU를 측정하는 것은 소장 경색을 진단하는데 유용한 방법이다.

Variceal embolization via periumbilical vein in portal vein thrombosis with variceal hemorrhage

노경훈,유선홍,권정현,남순우,이종율,심동재,변종현 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

호흡기 : 전이성 연골육종에 의한 폐동맥색전증 1예 (초)

장덕현,김창환,최락경,김계수,임달수,노영무,오삼세,심동재 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-

호흡기 : 급성호흡곤란증후군으로 발현하여 경피간침생검으로 진단한 좁쌀결핵 1예 (초)

현주용,김창환,장덕현,김계수,임달수,노영무,심동재,함의근 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-