Diffusion Weighted MRI Patterns Caused by Acute Border Zone Infarction

장한원,변우목 대한영상의학회 2008 대한영상의학회지 Vol.58 No.1

Purpose: We investigated the causes and mechanisms driving acute border zone infarctions using diffusion-weighted imaging (DWI). Materials and Methods: We analyzed DWI in 104 patients (male: 72 years, female: 32 years, age range: 44 to 84 years) with acute border zone infarction. The DWI patterns were classified as follows: pattern A- An acute border zone infarction combined with multiple small disseminated cortical infarctions, pattern B- An acute border zone infarction only. Results: The most common cause of acute border zone infarctions was extracranial internal carotid artery (ICA) stenosis (45 cases, 43%). Other causes included middle cerebral artery stenosis (22 cases, 21%), intracranial ICA stenosis (14 cases, 13%), unknown, (12 cases 12%), iatrogenic (6 cases, 6%) and cardiogenic (5 cases, 5%), respectively. The most common pattern for DWI was pattern A (83 cases, 80%). We performed a transcranial Doppler in 7 of 75 cases (11%), and found at least 1 embolic pulse. Conclusion: The most common pattern of DWI for acute border zone infarctions was pattern A. We propose that the mechanisms driving acute border zone infarctions are emboli coupled with hypoperfusion.

외상성 경동맥-경정맥 누공의 혈관 내 치료: 2 증례 보고

장한원,변우목,김재운,장철훈 대한영상의학회 2007 대한영상의학회지 Vol.56 No.2

We report 2 patients with a traumatic carotid- jugular fistula. The first patient suffered a deep neck penetrating injury. The external carotid-jugular fistula was demonstrated by 3-dimension CT angiography (3D CTA) and digital subtraction angiography (DSA). The patient was treated with coil embolization. The second patient suffered a gun shot injury to the neck. 3D CTA and DSA revealed a common carotid-jugular fistula and a pseudoaneurysm. The common carotid-jugular fistula was treated with coil embolization in the fistula and the pseudoaneurysm was treated with stent assisted coil embolization . 혈관 내 치료를 시행한 외상성 경동맥 - 경정맥 누공환자 두 증례를 보고하고자 한다. 첫 번째 환자는 경부 심부 관통상을 가졌으며 삼차원 전산화단층혈관조영술과 디지털감산혈관조영술에서 외경동맥 - 목정맥 누공이 보였고 코일 색전술로 치료하였다. 두 번째 환자는 경부 총상환자로 삼차원 전산화단층혈관조영술과 디지털감산혈관조영술에서 총경동맥 - 목정맥 누공과 가성동맥류가 동반되었으며 누공은 코일 색전술로 치료하였고 가성동맥류는 스텐트 보조 코일색전술을 시행하였다.

MR Imaging of a Cerebello-Pontine Angle Epidermoid Cyst with a Malignant Transformation: Case Report

장한원,변우목 대한영상의학회 2008 대한영상의학회지 Vol.59 No.1

The malignant transformation of an epidermoid cyst can be discovered at the same time as a pre-existing epidermoid cyst, or during a follow-up examination after an incomplete excision. We describe a rare case of malignant transformation of a cerebellopontine angle epidermoid cyst which extended into the middle cerebellar peduncle.

대뇌 피질을 침범한 Marchiafava-Bignami병: 증례 보고

장한원 대한영상의학회 2007 대한영상의학회지 Vol.56 No.3

Marchiafava-Bignami disease is a rare complication of chronic alcoholism and this malady typically manifests as callosal lesion. I report here on one patient with Marchiafava-Bignami disease (MBD) who has symmetric restricted diffusion in both lateral-frontal cortices, in addition to the callosal lesion. 마르키아파바-비나미(Marchiafava-Bignami)병은 만성알코올 중독에서 일어나는 드문 합병증으로서 특징적인 뇌량의 병변을 가지고 있다. 저자는 뇌량의 병변과 더불어 확산 강조영상에서 대칭적인 측전두엽 피질 확산 감소를 하는 1예를 보고한다.

전립선암 발견에 있어 경직장 초음파 검사의 유용성 : 전립선특이항원 수치가 10 ng/ml 이하인 환자를 대상으로 in Patients with Prostate Specific Antigen of 10 ng/ml or Less

장한원,조재호 영남대학교 의과대학 2004 Yeungnam University Journal of Medicine Vol.21 No.2

Background: This study was performed to reconsider the efficacy of transrectal ultrasonography (TRUS) in diagnosing prostate cancer by analyzing the results of a digital rectal examination (DRE), serum prostate-specific antigen (PSA) and a transrectal ultrasonography in patients with prostate specific antigen levels of 10 ng/ml or less. Materials and Methods: One-hundred and eighty one men with PSA levels of 10 ng/ml or less, who had a TRUS-guided tissue biopsy performed, were included in this study. The detection rate of prostate cancer was compared according to the TRUS result and the presence or absence of nodularity and the consistency of the prostate on DRE. Results: In a total 181 patients, there were 73 patients with PSA levels of 4 ng/ml or less and 4 of them had prostate cancer. Thre were 108 patients with PSA levels of 4-10 ng/ml and 18 of them were prostate cancer. TRUS was performed in 152 patients and 16 out of 58 patients diagnosed with prostate cancer, 3 out of 39 diagnosed with suspicious prostate cancer, and 2 out of 55 patients diagnosed as having no prostate cancer were found to have prostate cancer. In 40 patients, a nodule was palpated on DRE and 8 of them were found to have prostate cancer. Five out of 19 patients with a stony hard consistency, 3 of 12 with a firm to hard consisency, 12 of 129 with a firm consistency, 0 of 13 with a soft to firm consistency, and 2 of 8 with a soft consistency were prostate cancer. In the prostate cancer patients, there were 4 patients with PSA levels of 4 ng/ml or less and all these patients were diagnosed with prostate cancer or suspicious prostate cancer on TRUS but the nodule was not palpated in all patients. Two were soft and 2 were firm consistency on DRE. Conclusion: In patients with serum PSA levels of 10 ng/ml or less, TRUS is a more useful supporting method than DRE and a more active application of TRUS may lead to an early diagnosis and pertinent treatment of prostate cancer.

사춘기 이전 소아 고환기형종의 초음파 소견

장한원,조재호 대한초음파의학회 2005 ULTRASONOGRAPHY Vol.24 No.2

PURPOSE : To evaluate the ultrasonographic findings of testicular teratoma arising in pre-pubertal children. MATERIALS and METHODS : We studied 6 cases in 5 patients with pathologically proven testicular teratoma.Ultrasonography was performed in all cases and MRI in 5 cases. The location, size, shape, margin and internal echo pattern of the lesion were evaluated on ultrasonography and the shape, signal intensity and presence or absence of contrast enhancement were evaluated on MRI. RESULTS : The shape of all cases was round or oval and the lesion size ranged from 0.5 to 3.5 cm (average, 1.7 cm).Four of 6 cases were seen as cystic lesions, Three of which were multilocular and one was unilocular. The cystic lesions were filled with echo-free fluid without any solid component. The inner wall and septa were minutely granulated. One of 6 cases was seen as a predominantly cystic lesion containing heterogeneous, high echoic portions.One case was seen as a heterogeneous mixed echoic lesion with dirty posterior sonic shadowing. Three of the 4 cases seen as a cyst on ultrasonography were also seen as a cyst on MRI. In one case seen as a predominantly cystic lesion on ultrasonography, the periphery of the lesion was hypointense and the center was hyperintense on T2-weighted image. The remaining case seen as a heterogeneous mixed echoic mass was markedly heterogeneous in signal intensity both on T2-and T1-weighted images and hyperintense fat components were noted. Contrast enhancement was not seen in any of the 4 cases. CONCLUSION : On ultrasonography, pre-pubertal testicular teratoma is commonly seen as a multilocular or unilocular cyst and a minutely granulated appearance is noted in the inner wall or septa of the cystic lesion. 목적 : 사춘기 이전 소아에서 발생하는 고환기형종의 초음파 소견을 알아보고자 한다. 대상 및 방법 : 수술 후 병리학적으로 고환기형종으로 확진된 5명의 환아, 6예를 대상으로 하였다.모든 예에서 술전에 초음파 검사가 시행되었고, 5예에서는 자기공명영상이 시행되었다. 초음파 검사에서는 병변의 위치, 크기, 모양, 경계, 종괴 내부의 에코 양상을 알아보았고, MRI 에서는 병변의 모양, 신호강도 및 조영증강 여부를 알아보았다. 결과 : 초음파 검사에서 6예 모두 구형 또는 난형이었고, 크기는 0.5-3.5 cm으로 평균 1.7 cm이었다. 6예 중 4예는 낭성 병변으로 관찰되었는데, 이 중 3예는 다방성이었고, 1예는 단방성 이었다. 낭종의 내부는 순수한 액체로 차 있었고 고형 성분은 없었다. 낭종 벽과 격막이 미세과립형태로 관찰되었다. 6예 중 1예는 낭성 부분이 우세한 단방성 종괴로 관찰되었는데 내부에 불균일한 고에코 부분을 포함하고 있었고, 나머지 한 예는 지저분한 후방음향그림자들을 보이는 불균일한 혼합 에코로 관찰되었다. 초음파 검사에서 낭종으로 보였던 4예 중 3예는 MRI에서도 단순낭종으로 보였다. 내부에 불균일한 고에코 부분을 포함하고 있는 낭성으로 보였던 1예는 T2-강조영상에서 병변의 가장자리는 저신호강도로, 병변의 내부는 고신호강도로 보였다. 불균일한 혼합에코로 보였던 1예는 T2- 및 T1-강조영상 모두에서 불균일한 신호강도로 보였으며, 내부에 고신호강도를 보이는 지방 성분들이 관찰되었다. 조영증강을 시행한 4예 모두에서 조영증강은 관찰되지 않았다. 결론 : 사춘기 이전 소아에서 발생하는 고환기형종은 초음파 검사에서 다방성 또는 단방성 낭종의 형태를 보이는 경우가 많고, 낭종의 내벽이나 격막이 미세과립형태를 보인다.

신경베체트병의 자기공명영상소견

장한원,변우목,조길호,황미수 영남대학교의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.2

1994년 1월에서 1998년 8월까지의 영남대학교 의과대학 부속병원에서 신경베체트병으로 진단받은 9명의 환자를 대상으로 전신적인 임상증상과 자기공명영상소견을 분석한 결과 주된 전신적인 증상은 구강궤양, 안질환, 음부궤양이었으며, 자기공명영상소견에서 병소부위는 중뇌, 내포, 뇌교, 시상, 대뇌기저핵, 중소뇌각, 연수, 그리고 피지하단백질 순으로 호발되었다. 이들 병소는 T2강조영상에서 불균질의 고신호강도, T1강조영상에서 저신호 강도로 보였으며, 국소적인 조영증강이 비교적 흔하게 관찰되었다. 추적영상에서 병변의 호전 및 재발이 관찰되었으나 1년이상 추적검사에서 병변이 있던 부위에 뇌조직의 위축이 관찰되었다. 결론적으로 신경베체트병의 전신적인 임상증상과 특징적인 자기공명영상소견을 앎으로서 신경베체트병의 진단에 도움이 되리라 생각한다. MR findings in nine patients(three female, six male) with neuro-Behcet's disease were retrospectively analyzed. NeuroBehcet's disease was diagnosed on the basis of typical clinical symptoms. Involved site, pattern, signal intensity, and contrast enhancement pattern on MRI were evaluated. In addition, follow up MR imaging was performed in four patients. The midbrain(7/9), internal capsule(7/9), pons(6/9), thalamus(6/9), basal ganglia(5/9), middle cerebella peduncle(4/9), medulla oblongata(2/9) and subcortical white matter(2/9) are involved on MRI. The size of lesions was 1cm to 3cm and their margin was ill-defined and patchy. Inhomogeneous high signal intensity on the T2-weighted images and low signal intensity on T1-weighted images was seen respectvley. In four of nine cases, there was focal enhancement. On follow up MR imaging, improvement or recurrance of the lesions was found. Also in two cases of follow up cases, there was artophy in brainstem and(or) middle cerebellar peduncles. In conclusion, MR imaging with systemic clinical symptoms is useful for diagnosing neuro-Behcet's disease.

췌장에서 발생한 파골세포양 거대세포를 가지는 미분화 암종

장한원 ( Han Won Jang ),박원규 ( Won Kyu Park ),장재천 ( Jay Chun Chang ),김재운 ( Jae Woon Kim ),배영경 ( Young Kyung Bae ),최준혁 ( Jun Hyuk Choi ),윤성수 ( Sung Su Yun ),이동식 ( Dong Shik Lee ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of exocrine pancreas. Till recently, some cases have been reported, however histogenesis of the tumors are controversial and their characteristic findings have not been described yet. Thirty five-year-old men and 75-year-old men were presented with upper abdominal pain and a palpable mass. On computed tomography, one case showed a well enhancing solid tumor with low density and the other was showed a mainly cystic tumor with peripheral enhancement in the body and tail of the pancreas. One case accompanied multiple metastatic liver masses with subhepatic lymph node enlargement. Tumor staining was seen on angiography. Biopsy and pancreatectomy were performed. Pathological findings revealed tumors composed of neoplastic spindle shaped or pleomorphic large cells with scattered non-neoplastic osteoclast-like giant cells. In one case, there were small foci of adenocarcinoma components in the periphery of the tumor. On immunohistochemical stain, neoplastic cells showed focal positivity for epithelial membrane antigen and vimentin. Tumors were diagnosed as undifferented carcinoma with osteoclast-like giant cells. We report these rare cases with a review of literature. (Korean J Gastroenterol 2006;48:355-359)

Imaging Finding of Malignant Melanoma of Eustachian Tube with Extension to Middle Ear Cavity: Case Report

김홍철,장한원,이희중 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.6

We report a case of malignant melanoma of Eustachian tube with extension to the middle ear cavity and nasopharynx in a 51-year-old woman who presented with right ear fullness. Computed tomography showed a soft tissue mass in the middle ear cavity and causedthe widening and eroding of the bony eustachian tube. Magnetic resonance imaging showed well enhancing mass in eustachian tube extending nasopharynx to middle ear cavity. A biopsy of the middle ear cavity mass revealed a malignant amelanotic melanoma.

음경의 요도배오목에 발생한 이행세포암종의 초음파 및 자기공명영상 소견: 증례 보고

이승우,조재호,장한원,김동석,문기학 대한영상의학회 2004 대한영상의학회지 Vol.51 No.2

Primary carcinoma of the male urethra are rare. Among the malignant tumors of the male urethra, squamous cell carcinoma is the most common. Transitional cell carcinoma is very rare, particularly in the distal urethra. We experienced a case of distal urethral transitional cell carcinoma, arising at the fossa navicularis of the penis, which we report here with a review of the literature. A 68-year-old male patient presented with bloody discharge from the prepuce for 1 month. Ultrasonography showed a poorly marginating, heterogeneous mass, invading the glans penis and the corpus spongiosum. The mass encircled the glandular urethra of the penis glans, and obstructed the glandular urethra and the fossa navicularis. A Doppler ultrasonogram revealed hypervascularity in this mass. The mass was isointense to the corpus carvernosum on the T1-weighted images and slightly hypointense to the corpus carvernosum on the T2-weighted images. Contrast-enhanced MR imaging showed a poorly enhancing mass in the glans penis. This mass was confirmed as a transitional cell carcinoma by histologic study and a partial penectomy was performed. 남성 요도에 생기는 원발성 종양은 드문데, 악성 병변으로는 편평세포암종이 가장 흔하며 이행세포암종은 극히 드문 것으로 알려져 있고, 특히 이행세포암종은 원위부 요도에 거의 발생하지 않는 것으로 알려져 있다. 저자들은 요도배오목의 요도 상피에서 기원하여 음경귀두에 종괴를 형성한 이행세포암종을 경험하였기에 문헌고찰과 함께 방사선 소견을 보고하고자 한다. 환자는 1개월 동안의 음경 포피의 혈성 분비물을 주소로 내원한 68세 남자로서, 초음파 검사상원위부 해면체와 음경귀두를 침범하여 귀부요도를 둘러싸고 있는, 경계가 불분명한, 불균질한 저에코의 종괴가 관찰되었고, 병변은 귀부요도와 요도배오목을 막고 있었다. 도플러 초음파에서는 과혈관성 종괴로 보였다. 자기공명 T1-강조영상에서는 해면체와 등신호강도의 종괴로 관찰되었고, T2-강조영상에서는 해면체보다 저신호강도의 종괴로 보였다. 조영증강 T1-강조영상에서 종괴는 거의 조영증강되지 않았다. 조직 검사에서 이행세포암종으로 확진되어 부분음경절제술을 시행하였다.