유방자기공명영상의 임상 적용

조나리야,문우경 대한자기공명의과학회 2009 Investigative Magnetic Resonance Imaging Vol.13 No.1

유방 MRI는 유방 질환의 진단과 치료 분야에 최첨단 기법으로서 지난 10년 동안 유방 MRI는 연구 분야에서 임상 분야로 진화해 왔다. 따라서, 유방 MRI의 적응증과 적절한 영상을 얻는 방법, 소견을 해석하고 보고하는 법에 대한 이해가 필요하다. 유방 MRI는 양성과 악성 종괴의 감별, 유방암 환자의 수술 전 병기 결정, 수술전 항암요법에 대한 종양의 반응 평가, 유방 성형 여성의 평가 등에 사용되고 있다. 또한 유방암 고위험군 여성에서 선별 보조 검사로서 사용될 수 있다. 이러한 목적을 성공적으로 이루기 위해서는 적절한 MRI기법과 다른 유방 영상 소견과 연관 지어 해석할 수 있는 영상의학과 의사가 중요하다. 본 소고에서는 유방 MRI의 적응증, 표준화된 용어와 카테고리의 사용에 중점을 두어 기술하고자 한다. Breast MRI is a cutting-edge technology in the diagnosis and intervention of breast abnormalities. Over the last decade, breast MRI has evolved from a research field to a clinical field. Radiologists should understand the indications, how to obtain adequate images, and how to interpret and report their findings. Breast MRI is now used in the differentiation of benign from malignant mass, preoperative staging of breast cancer patients, assessment of tumor response to neoadjuvant chemotherapy, and evaluation of women with breast implants. It can also be used as a supplemental screening modality for high-risk women. Qualified radiologists and adequate MRI technique are crucial for the success of these purposes. This review is focused on the indication, standardized use of lexicon and categorization of breast MRI.

Imaging features of breast cancer molecular subtypes: state of the art

조나리야 대한병리학회 2021 Journal of Pathology and Translational Medicine Vol.55 No.1

Characterization of breast cancer molecular subtypes has been the standard of care for breast cancer management. We aimed to provide a review of imaging features of breast cancer molecular subtypes for the field of precision medicine. We also provide an update on the recent progress in precision medicine for breast cancer, implications for imaging, and recent observations in longitudinal functional imaging with radiomics.

Molecular subtypes and imaging phenotypes of breast cancer

조나리야 대한초음파의학회 2016 ULTRASONOGRAPHY Vol.35 No.4

During the last 15 years, traditional breast cancer classifications based on histopathology have been reorganized into the luminal A, luminal B, human epidermal growth factor receptor 2 (HER2), and basal-like subtypes based on gene expression profiling. Each molecular subtype has shown varying risk for progression, response to treatment, and survival outcomes. Research linking the imaging phenotype with the molecular subtype has revealed that non-calcified, relatively circumscribed masses with posterior acoustic enhancement are common in the basallike subtype, spiculated masses with a poorly circumscribed margin and posterior acoustic shadowing in the luminal subtype, and pleomorphic calcifications in the HER2-enriched subtype. Understanding the clinical implications of the molecular subtypes and imaging phenotypes could help radiologists guide precision medicine, tailoring medical treatment to patients and their tumor characteristics.

Nonpalpable Breast Masses: Evaluation by US Elastography

조나리야,문우경,박정선,Joo Hee Cha,Mijung Jang,Min Hyun Seong 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.2

Objective: To compare the diagnostic performances of conventional ultrasound (US) and US elastography for the differentiation of nonpalpable breast masses, and to evaluate whether elastography is helpful at reducing the number of benign biopsies, using histological analysis as a reference standard. Materials and Methods: Conventional US and real-time elastographic images were obtained for 100 women who had been scheduled for a US-guided core biopsy of 100 nonpalpable breast masses (83 benign, 17 malignant). Two experienced radiologists unaware of the biopsy and clinical findings analyzed conventional US and elastographic images by consensus, and classified lesions based on degree of suspicion regarding the probability of malignancy. Results were evaluated by receiver operating characteristic curve analysis. In addition, the authors investigated whether a subset of lesions was categorized as suspicious by conventional US, but as benign by elastography. Results: Areas under the ROC curves (Az values) were 0.901 for conventional US and 0.916 for elastography (p = 0.808). For BI-RADS category 4a lesions, 44% (22 of 50) had an elasticity score of 1 and all were found to be benign. Conclusion: Elastography was found to have a diagnostic performance comparable to that of conventional US for the differentiation of nonpalpable breast masses. The authors conclude that BI-RADS category 4a lesions with an elasticity score of 1 probably do not require biopsy.

이소성 갑상선의 임삼 및 방사선학적 소견

조나리야 대한영상의학회 1998 대한영상의학회지 Vol.38 No.3

Purpose : To understand the various clinical and radiological features of ectopic thyroid. Materials andMethods : This study involved nine ectopic thyroid cases (M:F=2:7; age range, 2-57 years) confirmed by RI thyroidscan between 1993 and 1997. We analyzed one neck ultrasonogram, five CT scans, three MR images, nine Tc-99mthyroid scans, and classified the ectopic thyroid by the basis of these findings. Hormonal abnormalities andsymptoms were evaluated on the basis of medical records. Results : The status of nine patients was found to beeuthyroid (n=6), hypothyroid (n=2) or hyperthyroid (n=1). Among the nine, the ectopic thyroid was lingual (n=6),sublingual (n=3) or thyroglossal (n=1); one patient had both the lingual and sublingual types. Ectopic thyroid wasseen as a well-defined round mass, homogeneously enhanced on CT scan, homogeneously hyperechogenic onultrasonogram and of intermediate signal intense on MRI. All cases showed ectopic radioactivity uptake on Tc-99mthyroid scan. In eight patients, ectopic thyroid was the only hormone-producing thyroid tissue; one had bothnormal thyroid and ectopic thyroid tissue in a thyroglossal duct cyst. Among the six cases of euthyroidism,ectopic thyroid patients with the lingual type complained of throat discomfort. Those with the sublingual typecomplained of palpable neck mass, and preoperative evaluation of thyroglossal duct cyst showed that this wasectopic thyroid. Conclusion : Understanding the various clinical and radiologic features of ectopic thyroid canhelp accurate diagnosis and prevent unnecessary surgery or other procedure.

비전형적 유방섬유선종의 종괴내부 초음파 소견과 병리학적 소견의 연관성

조나리야 대한영상의학회 1998 대한영상의학회지 Vol.39 No.1

Purpose : To understand the cause of atypical sonograpic findings by analyzing their pathologic correlation to internal echogenicity of breast fibroadenoma. Materials & Methods : Between January 1995 and April 1997, the presence of 91 fibroadenomas in 81 patients was histopathologically proven. These mass lesions were sonographically interpreted and their descriptive criteria-internal echo content (both strength and homogeneity), the presence of septum, bilateral shadowing, and posterior echo pattern-were tabulated. A pathologist reviewed each case and independently recorded the following data : cell type, the presence of septum, duct dilatation, calcification, fibrosis, hyalinization, and vascularity. We analyzed the correlation of sonographic with pathologic findings. Results : There was significant correlation between increased vascularity and increased internal echo strength and between increased fibrosis and decreased internal echo strength. There was no significant correlation between internal echo homogeneity or posterior shadowing and vascularity or stromal fibrosis, nor between hyalinization or cell type and internal echo strength, homogeneity or posterior shadowing. There was correlation between absent or thin capsule and the absence of bilateral shadowing. Conclusion : Increased vascularity or decreased stromal fibrosis might be the cause of atypical fibroadenoma.

Imaging diagnosis

조나리야 대한외과학회 2013 대한외과학회 학술대회 초록집 Vol.2013 No.11

유방암 스크리닝 자기공명영상

조나리야,문우경 대한자기공명의과학회 2012 Investigative Magnetic Resonance Imaging Vol.16 No.1

Breast MRI is the most accurate adjunctive to the mammography for the screening of breast cancer. Despite lack of randomized controlled trials on the effectiveness of MRI screening, it is now recommended for the women at high risk for breast cancer by the American Cancer Society and the National Comprehensive Cancer Network based on several prospective observational studies. In Korea, a retrospective study reported that preoperative MRI screening of the contralateral breast in women with unilateral breast cancer was associated with reduced metachronous cancer incidence. To introduce breast MRI as a supplemental modality to screening mammography in Korea, standardization and education of interpretation, establishment of MR-guided biopsy and adequate indication,and evaluation of cost-effectiveness and should be preceded. 유방 MRI는 유방암의 유방촬영 스크리닝법에 대한 가장 정확한 보완 검사법이다. 아직까지 MRI 스크리닝의 효과에 대한 무작위 대조군연구가 없음에도 불구하고, 현재 미국암학회와 국립 종합암네트워크 (NCCN)에서는 MRI 스크리닝을 유방암고위험여성에서 권고하고 있다. 국내에서는, 한 후향적 연구에서 유방암 환자의 반대쪽 유방암에 대한 MRI 스크리닝법이 유방촬영술과 초음파에서 발견하지 못한 암을 발견하고 이는 이후 유방암 발병을 감소시킴을 보고하고 있다. 국내에 유방촬영스크리닝법의 보완법으로 MRI를 도입하기 위해서는 판독의 표준화와 교육, MR 유도하 조직검사법과 적절한 적응증의 확립,비용-효용성에 대한 평가가 선결되어야 한다.

디지털 유방촬영술

조나리야,차주희,문우경 대한영상의학회 2005 대한영상의학회지 Vol.52 No.4

Mammography is the best imaging modality for the detection of early breast cancer in asymptomatic women. However, 10-30% of cases are missed with current film-screen mammography. Digital mammography allows for the separate optimization of image acquisition and display. In addition to the obvious data storage, retrieval, and transmission advantages that digital mammography allows, additional advances such as computer-aided diagnosis, tomosynthesis and dual energy mammography are in development. This review will discuss the technology of digital mammography including detectors and displays, the results of clinical trials comparing film-screen and digital mammography, and the use of computer-aided detection. Digital mammography is a promising new technology for breast cancer detection in the Korean women. 유방촬영술은 무증상 여성에서 유방암을 조기 발견하는데 최선의 방법이다. 하지만 기존의 필름-스크린 유방촬영술은 낮은 관용도와 잡음으로 인해 10-30%정도의 유방암을 간과할 수 있다. 디지털 유방촬영술은 영상 획득과 표시가 분리되어 있다. 디지털 유방촬영술은 데이터의 저장, 검색 및 전달 등의 장점이외에도 컴퓨터보조진단, 단층촬영기, 이중에너지 유방촬영술 등도 가능하게 한다. 이 글에서는 최근 유방방사선과학 분야의 최고 관심 영역인 디지털유방촬영술의 도입배경 및 장점, 기술적 원리, 임상연구 결과, 컴퓨터보조진단 및 향후 전망등 에 관해 토론하고자 한다. 디지털 유방촬영술은 우리나라 여성의 유방암 발견에 유망한 신기술이다.

쇄골하동맥스틸현상의 색혈류영상 소견

조나리야 대한영상의학회 1997 대한영상의학회지 Vol.36 No.3