하지의 페색성 혈관 질환의 감산 동맥 조영술

오경승 대한영상의학회 1990 대한영상의학회지 Vol.26 No.6

In recent years, digital subtraction angiography(DSA) has assumed a greater clinical and surgical significance, especially since the advent of arterial grafting for occlusive arterial disease. Evaluation of the site and extent of segmental occlusion, the state of the distal arterial tree and the degree of collateral circulation can best be obtained by DSA. from January 1987 to July 1989. DSA was performed on 19 occlusive arterial disease of the lower extremity : 12 arteriosclerosis obliterans and 7 Buerger's disease. The subjects were 19 patients ranging form 18 to 76 years of age. All patients were male. average age of patients with arteriosclerosis obliterans/Buerger's disease was 63 and 35, respectively. The angiographic findings were abrupt occlusion or irregular narrowing with arteriosclerotic change of aorta in arteriosclerosis obliterans and abrupt occlusion or narrowing without arteriosclerotic change of aorta in Buerger's disease. the most frequently involved artery n occlusive disease was superficial femoral artery (10/19). Run-off artery shows in 7 cases of arteriosclerosis obliterans and in 3 cases of Buerger's disease. arteriography is the most valuable diagnostic tool to confirm the occlusive vascular disease and also to decide appropriate treatment modality.

원발성 소장 악성 종양의 방사선학적 소견

오경승 대한영상의학회 1990 대한영상의학회지 Vol.26 No.3

Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and/or computed tomograhy(CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesions were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma(N=15) and was next common lymphoma(N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture(66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was mor accurate in detecting secondary findings.

다발성 식도 협찾을 동반한 영양장애성 수포성표피박리증 : 1예 보고

오경승 대한영상의학회 1998 대한영상의학회지 Vol.38 No.2

영양장애성 수포성표피박리증은 수포가 생기는 희구한 만성 유전성피부질환이다. 이질환은 피부외에 점박, 식도와 항문같은 다른 중층편평상피에도 병변을 야기하며 식도에서는 수포가 자연 치유되어 협착이 잘생긴다. 전형적인 피부병변은 마찰이 많은 사지에 발생되고 손, 발톱의 탈락과 손과 발의 관절에 굴곡구축 그리고 벙어리 장박모양의 변형이 손에서 관찰되며 손과발의 단순X-선 촬영에서 말단 지골에 첨상기형(Pointed-shaped deformity)이 보인다. 식도조영검사에서 상부식도와 하부식도에 다발성 분절협착과 궤양이 있었으며 풍선카테터를 이용한 식도확장술을 시행하여 증상의 호전을 보인 1예를 보고한다. Epidermolysis bullosa dystrophica is a rare skin disease characterized by milia, nail dystrophy, andblistering of the skin and mucous membranes in response to minimal trauma. A forty years old man had typical skinlesions on the extremities, and the presence of distal phalangeal wedge deformity with soft tissue webbing wasnoted. multiple segmental strictures and ulceration involved the cervical and distal esophagus. Esophageal balloondilatation was therefore performed and dysphagia was relieved. The authors describe a case involving multipleesophageal strictures and musculoskeletal lesion, with clinically and radiologically documented epidermolysisbullosa dystrophica.

Supraclavicular Lymph Node Metastasis from Various Malignancies: Assessment with 18F-Fluorodeoxyglucose Positron Emission Tomography/CT, Contrast-Enhanced CT and Ultrasound

류은비,오경승,정경순 대한영상의학회 2012 대한영상의학회지 Vol.66 No.1

Purpose: The purpose of this study is to compare the usefulness of 18F-fluorodeoxy¬glucose positron emission tomography (18F-FDG PET)/CT, contrast-enhanced CT and ultrasound (US) for diagnosing metastatic supraclavicular lymph nodes. Materials and Methods: This study included 53 supraclavicular lymph nodes of 48 consecutive patients with various malignancies observed on 18F-FDG PET/CT, contrast-enhanced CT and US. Detection of supraclavicular lymph nodes was determined by 18F-FDG PET/CT where uptake was greater than that of surrounding tissue and con¬trast-enhanced CT with a node short-axis diameter of 5 mm or more. On US, we clas¬sified the supraclavicular lymph node as benign or malignant by sonographic criteria. The diagnostic values of these modalities were compared in the detection of meta¬static supraclavicular lymph nodes. Results: Metastatic supraclavicular lymph nodes were diagnosed cytologically in 44 (83%) of 53 lesions. In the detection of metastatic supraclavicular lymph nodes, the diagnostic accuracies of 18F-FDG PET/CT, contrast-enhanced CT, and US were 92%, 89%, and 91%, respectively. The specificity (67%) and negative predictive value (86%) of 18F-FDG PET/CT were higher than those of contrast-enhanced CT and US. Conclusion: 18F-FDG PET/CT is more useful for detecting and characterizing supra-clavicular lymph nodes in patients with cancer, because of its high specificity and negative predictive value.

두경부암 치료 후 국소재발 및 전이에 대한 18FFDG PET/CT와 CT/MRI의 정확도 비교

권진환,오경승,조영덕,이강대,이석모,정미희,고지호 대한영상의학회 2007 대한영상의학회지 Vol.56 No.6

Purpose: We evaluated the accuracy of 18FFDG PET/CT for the detection of recurrence or metastasis after treatment in patients with primary head and neck cancer, and compared the results with those of CT/MRI. Materials and Methods: We studied 34 patients with the diagnosis of head and neck cancer, who underwent treatment and follow up with 18FFDG PET/CT and CT/MRI. The patients were divided into two subgroups based on the difference In follow-up time interval and the type of treatment. Accuracy was evaluated by follow-up information and histopathology findings. The results of the 18FFDG PET/CT and CT/MRI were compared by statistical analysis. Results: For the 18FFDG PET/CT results, 19 FDG uptake lesions were detected in 17 patients. Among these lesions, 18 were confirmed as recurrent or metastatic lesions and one as an inflammatory reaction from radiation therapy. Four lesions that had high FDG uptake were not detected by the CT/MRI. The sensitivity and specificity were 100% and 94.4% for the 18FFDG PET/CT and 77.8% and 94.4% for the CT/MRI (p<0.05). For the subgroup that received radiation therapy, 18FFDG PET/CT was more sensitive than CT/MRI (sensitivity = 100% vs. 63.6%, p<0.05). Conclusion: The results of this study showed that 18FFDG PET/CT was a useful screening modality for detecting recurrent or metastatic disease after treatment of patients with head and neck cancer, especially post-radiation. 목적: 두경부암 치료 후 병변의 재발 유무 및 전이의 평가에서 18FFDG PET/CT와 CT/MRI의 진단적 정확성을 비교하고자 한다. 대상과 방법: 두경부암으로 진단받고 수술 혹은 방사선 치료 후 18FFDG PET/CT와 CT/MRI를 시행한 34명의 환자를 대상으로 비교하였으며, 모든 결과에 대하여 조직검사 또는 임상적으로 확진 한 후, 각 방법의 민감도, 특이도를 측정하고, 추적 기간 및 치료 방법의 차이를 구분하여 비교하였다. 결과: 18FFDG PET/CT에서 섭취 증가를 보이는 19예의 병변 중 1예를 제외하고 모두 재발성 혹은 전이성 병변으로 확인되었으나, CT/MRI에서 병변을 확인할 수 없는 예는 4예였다. 1예는 두 검사방법에서 재발성 병변으로 보였으나, 조직학적으로 섬유화 병변으로 밝혀졌다. 18FFDG PET/CT의 민감도, 특이도는 각각 100%, 94.4%였으며, CT/MRI는 각각 77.8%, 94.4%이었다(p < 0.05). 추적기간에 따른 차이는 두 검사방법에서 통계적 유의성이 없었으나, 치료방법에 따른 차이에서 방사선치료를 받은 경우 18FFDG PET/CT의 민감도는 100%, CT/MRI는 63.6%로 18FFDG PET/CT가 CT/MRI보다 민감도가 우수하였으며 통계적으로 유의한 차이를 보였다(p < 0.05). 결론: 18FFDG PET/CT는 두경부암 환자의 치료 후 평가에서 상대적으로 높은 민감도를 보이며, 특히 방사선 치료를 받은 환자에 있어 재발 또는 전이 여부를 평가함에 있어 유용한 선별검사로 여겨진다.

소장에서 발생한 위장관 간질종양과 림프종의 CT 소견

정미희,오경승,이승룡,이은정,고지호,김성협,장희경,허진도,조영덕 대한영상의학회 2005 대한영상의학회지 Vol.53 No.3

Purpose: To compare CT features of gastrointestinal stromal tumors (GIST) with those of lymphomas in the small intestine. Materials and Methods: CT findings of 11 pathologically confirmed GIST patients and 10 lymphoma patients were retrospectively reviewed. CT findings were analyzed with regard to location, size, margin, growth patterns, internal character, enhancement, invasion, vascular encasement, lymphadenopathy, intestinal obstruction and ascites. Results: An extraluminal mass was present in 82% (9/11) of the GIST patients versus 30% (3/10) of the lymphoma patients. Circumferential wall thickening was observed in 80% (8/10) of the lymphoma patients (p<.05). Internal necrosis or gas was present in 73% (8/11) of the GIST patients versus 10% (1/10) of the lymphoma patients (p<.05). Inhomogeneous enhancement was observed in 63% (7/11) of the GIST patients compared to homogeneous enhancement in 90% (9/10) of the lymphoma patients (p<.05). Lymphadenopathy was only observed in 80% (8/10) of the lymphoma patients (p<.05). In other findings such as fatty infiltration, ascites and intestinal obstruction there were no statistically significant differences (p>.05). Conclusion: Features revealed by CT scans are highly useful in differentiating GIST from lymphoma of the small intestine. Extraluminal growth and internal necrosis or gas are more common in patients with GIST compared with lymphoma. CT features of circumferential wall thickening and associated lymphadenopathy are more common in patients with lymphoma. 목적: 소장에서 발생한 위장관 간질종양과 림프종의 CT 소견을 분석하여 두 질환의 차이점을 알아보고자 하였다. 대상과 방법: 1999년 1월부터 2005년 3월까지 병리 조직학적으로 확진된 소장의 위장관 간질종양과 림프종 환자들을 대상으로 하였다. 소장의 위장관 간질종양은 11명이였고 림프종은 10명이였다. CT 영상은 종양의 위치, 크기, 경계, 종양의 성장 양상, 조영 증강 균일도, 내부성상(괴사, 공기 음영, 석회화) 등을 분석하였고 종양의 주변 장기로의 침습, 주위 혈관 포획, 림프절 종대, 장 폐색 유무, 복수 유무 등을 분석하였다. 결과: 종양의 성장 양상은 위장관 간질종양의 9예(82%)에서 내강 외 성장을 보였고 림프종의 8예(80%)에서 미만성 장벽 비후 소견을 보였다(p < .05). 위장관 간질종양의 8예(73%)에서 내부 성상의 변화를 보였으나 림프종에서는 1예에서만 내부에 작은 저음영의 괴사를 보였다(p<.05). 위장관 간질종양의 7예(63%)에서 비균일한 조영 증강을 보였고 림프종의 9예(90%)에서 균일한 조영 증강이 보였다(p < .05). 림프종의 8예(80%)에서 림프절 종대가 관찰되었으나 위장관 간질종양에서는 한 예에서도 관찰되지 않았다(p < .05). 주변 장간막으로의 침습은 위장관 간질종양에서 4예, 림프종에서 3예에서 관찰되었다. 위장관 간질종양의 3예(27%)에서 소량의 복수가 관찰되었다. 장 폐색은 장 중첩증이 있었던 림프종의 2예를 제외하고 두 질환 모두에서 관찰되지 않았다. 주변 장간막으로의 침습, 복수와 장폐색의 유무에 대한 소견들은 두 질환 간 통계적 유의성이 관찰되지 않았다(p > .05). 결론: 내강 외 성장을 보이면서 주위 림프절 종대를 동반하지 않는 경우에는 위장관 간질 종양을, 미만성 장벽 비후를 보이면서 림프절 종대를 동반하는 경우는 소장의 림프종을 생각할 수 있다. 특히 내부의 괴사나 공기 음영을 가지는 경우에 림프절 종대를 관찰하는 것이 이 두 질환을 감별하는 데 유용한 지표가 될 수 있을 것으로 생각된다.

악성 십이지장 협착: 피복형 팽창성 나이티놀 스텐트 설치술을 이용한 고식적 치료

송호영,김성민,오경승,허진도,조영덕,정규식,Song, Ho-Yeong,Kim, Seong-Min,O, Gyeong-Seung,Heo, Jin-Do,Jo, Yeong-Deok,Jeong, Gyu-Sik 대한영상의학회 2002 대한영상의학회지 Vol.46 No.4

목적: 악성 십이지장 협착에 대한 폴리우레탄 피복형 팽창성 나이티놀 스텐트 설치술의 용이성 과 치료효과를 알아보았다. 대상과 방법: 심한 오심과 반복되는 구토의 병력을 가진 악성 십이지장 협착 환자 12명에 대해 투시하에 폴리우레탄 피복형 팽창성 나이티놀 스텐트를 설치하였다. 협착의 원인질환은 십이지장암 4예, 췌장암 4예, 담낭암 2예, 원위부 담관암 1예, 그리고 자궁경부암 1예였다. 협착 부위는 십이지장 I부가 1예, II부가 8예, 그리고 III부가 3예였다. 십이지장 II부의 협착이 있었던환자 8명 모두 시술 전에 황달이 선행되어 담도감압술을 시행하였다. 외경 6 mm 유도관을 이용하여 after-loading 방법으로 직경 16 mm의 스텐트를 설치하였다. 결과: 10명의 환자에서 스텐트 설치에 성공하였고, 시술과 관련된 합병증은 없었다. 시술에 실패한 2명은 병변이 모두 십이지장 III부에 있었으며, 이중 1명은 transgastric approach를 통해 스텐트를 설치하였다. 1명에서 시술 4일째 스텐트의 하방 전위(migration)가 발생하였고, 이후비피복 스텐트를 설치하였다. 스텐트 설치 후 모든 환자에서 증상이 호전되었다. 추적기간 중3명의 환자에서 증상의 재발이 있었으며, 증상재발의 원인은 스텐트 재협착(n=1), 대장협착(n=1), 소장의 다발성 협착(n=1)이었다. 이들 중 2명의 환자에게 각각 십이지장 스텐트와 대장 스텐트를 설치함으로 증상이 호전되었다. 십이지장 II부에 병변이 있어 스텐트를 설치한 환자 8명 중 1명에서 시술 후 황달이 발생하였다. 추적기간중 11명의 환자 모두 사망하였으며평균 생존기간은 14주(중앙값, 9주)였다. 결론: 악성 십이지장 협착에서 폴리우레탄 피복형 팽창성 나이티놀 스텐트 설치술은 비교적 시술이 어렵지 않고 안전하며 효과적인 치료방법으로 생각된다. Purpose: To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Materials and Methods: Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and part III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, an after-loading technique was used. Results: Stent placement was technically successful in ten patients, and no procedural complications occurred. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the placement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms [due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstructions (n=1)] recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died at mean 14 (median, 9) weeks after stent placement.

흉골의 골내 신경초종: 1예 보고

정경화,이상희,오경승,정규식,허진도,조영덕,김종인,조성래,장희경 대한영상의학회 2002 대한영상의학회지 Vol.47 No.4

Intraosseous neurilemmoma is a rare benign neoplasm that accounts for less than 1% of all primary bone tumors. The most frequent site of involvement is the mandible. We report a case of intraosseous neurilemmoma of the sternum which was discovered incidentally. 골내 신경초종은 원발성 골종양의 1% 미만을 차지하는 매우 드문 양성 종양으로서 하악골에서 가장 호발하는 것으로 알려져 있다. 저자들은 25세 남자 환자에서 우연히 발견된 흉골의 골내 신경초종 1예를 보고하고자 한다.

골육종의 흉곽내 전이형태

이승룡,정규식,오경승,고지호,허진도,조영덕 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

The purpose of this study is to evaluate findings of altered patterns of thoracic metastasis in patients treated for osteosarcoma with adjuvant chemotheapy. The author reviewed medical records and image findings of 60 osteosarcoma patients from 1991 to 1997. 18 patients had thoracic metastasis confirmed by needle biopsy(n=1) and clinical evidence of tumor progression(n=17). CT was available in 17 patients. In 6 patients, mean 3 times serial CT were obtained during follow-up period. Two radiologists retrospectively reviewed the CT findings of parenchymal lesion, pleural lesion, mediastinal lesion, lymphadenopathy, calcification, and the follow-up change. In 16 cases, single or multiple nodules, suggesting typical appearance of hematogeneous metastasis, were present. Pleural plaque or mass was present in seven cases. In two of these cases, small curvilinear calcification or calcific dot was noted along the pleura, initially. On serial follow up CT scans, these calcifications was gradually increased in size, which resulted in huge calcified pleural mass. One patient showed only diffuse pleural thickening without other involvement, which proved pleural metastasis of osteosarcoma by means of pleural biopsy. Linear calcification or calcified nodule along the bronchial wall was noted in three cases this finding gradually changed to huge calcified mass with associated atelectasis of lung parenchyma. Other sites of metastasis were pericardium, 3 patients, and lymph node, 4 patients. Interlobular septal thickening suggesting lymphangitic metastasis was noted in 2 patients. Calcification within parenchymal nodule and metastatic lymph node was seen in 7 patients. Pneumothorax was noted in 2 patients. Interestingly, parenchymal lesion was slowly increased in size and number, while pleural and endobronchial lesion revealed rapid change and affressive invasion into the parenchyma, mediastinum and chest wall on follow-up CT scans. Thoracic metastasis of osteosarcoma commonly presents hematogenous parenchymal nodules. However, adjuvant chemotherapy has resulted in prolonged survival, and may raised the unusual appearance of thoracic metastasis, which is more aggressive nature. We carefully concluded that any type of calcification should be suspected metastasis in osteosarcoma patient.

골육종의 흉곽내 전이형태

이승룡,정규식,오경승,고지호,허진도,조영덕 고신대학교(의대) 고신대학교 의과대학 학술지 2004 고신대학교 의과대학 학술지 Vol.19 No.1

The purpose of this study is to evaluate findings of altered patterns of thoracic metastasis in patients treated for osteosarcoma with adjuvant chemotherapy. The author reviewed medical records and imaging findings of 60 osteosarcoma patients from 1991 to 1997. 18 patients had thoracic metastasis confirmed by needle biopsy (n=1) and clinical evidence of tumor progression (n=17). CT was available in 17 patients. In 6 patients, mean 3 times serial CT were obtained during follow-up period. Two radiologists retrospectively reviewed the CT findings of parenchymal lesion, pleural lesion, emdiastinal lesion, lymphadenopathy, calcification, and the follow-up change. In 16 cases, single or multiple nodules, suggesting typical appearance of hematogeneous metastasis, were present. Pleural plaque or mass was present in seven cases. In two of these cases, small curvilinear calcification or calcific dot was noted along the pleura, initially. On serial follow up CT scans, these calcifications was gradually increased in size, which resulted in huge calcified pleural metastasis of osteosarcoma by means of pleural biopsy. Linear calcification or calcified nodule along the bronchial wall was noted in three cases. This finding gradually changed to huge calcified mass with associated atelectasis of lung parenchyma. Other sites of metastasis were pericardium, 3 patients, and lymph node, 4 patients. Interlobular septal thickening suggesting lymphangitic metastasis was noted in 2 patients. Calcification within parenchymal nodule and metastatic lymph node was seen in 7 patients. Pneumothorax was noted in 2 patients. Interestingly, parenchymal lesion was slowly increased in size and number, while pleural and endobronchial lesion revealed rapid change and aggressive invasion into the parenchyma, mediastinum and chest wall on follow-up CT scans. Thoracic metastasis of osteosarcoma commonly presents hematogenous parenchymal nodules. However, adjuvant chemotherapy has resulted in prolonged survival, and may raised the unusual appearance of thoracic metastasis, which is more aggressive nature. We carefully concluded that any type of calcification should be suspected metastasis in osteosarcoma patient.