간문부 담관암과 양성담관협착의 세절편 나선식 전산화단층촬영소견 : 담관조영술과의 비교

최국명 대한영상의학회 1997 대한영상의학회지 Vol.37 No.4

Purpose : The purpose of this study was 1) to describe the thin section helical CT findings of hilar cholangiocarcinoma and of benign stricture, and to discuss the differential points between the two disease entities and 2) using cholangiographic correlation, to evaluate the diagnostic accuracy of helical CT in determining the extent of hilar cholangiocarcinoma.Materials and Methods : Twenty-seven patients with hilar cholangiocarcinoma and eight with benign biliary dilataton were studied. All except four with heilar cholangiocarcinoma, who underwent CT using a conventional scanner, were studied with two-phase helical CT. In all patients, cholangiographs were obtained by digital fluoroscopy after the injection of contrast materials into PTBD catheters. The level of obstruction was classified according to Bismuth, and 35 CT scans were studied blindly and retrospectively by two radiologists. The findings were analyzed for the presence of tumor, and then divided into two groups(cholangiocarinomas and benign strictures), and the positive predictive value was calculated. The CT images of klatskin tumor were analyzed with special emphasis on the level and shape of the hilar obstruction. The level of biliary obstruction and extent of the tumor were carefully corelated with the results of cholangiography.Results : Thin-section spiral CT correctly identified all tumor mass as a focal wall thickening obliterating the lumen. On arterial/portal phase CT scanning, 81% of infilterative tumors showed high attenuation. In all patients, differentiation between benign stricture and klatskin tumor was possible ; correct identificaton of the level of obstruction and extent of tumor, according to Bismuth's classification, was possible in 63% of cases.Conclusion : For correct diagnosis of hilar cholangiocarcinoma and differentiation of benign stricture, helical CT was highly accurate and effective. Because of limital Z-axis resolution, however, the exact intraductal extent of the tumor was less accorately diagnosed.

두대저 중심부의 척색종과 연골육종 : MR과 CT 소견

최국명 대한영상의학회 1998 대한영상의학회지 Vol.38 No.2

Purpose : It is known that due to both their imaging and pathologic features, the accurate differentiation ofchondrosarcoma from chordoma is difficult. Through an analysis of MR and CT findings, this study aims to determinethe differential points between these two tumors. Materials and Methods : In 21 patients, CT and MR imagingstudies of chordoma(n=12) and chondrosarcoma(n=9) at the base of the skull were retrospectively reviewed.Diagnosis had been established by histologic examination of surgically removed specimens. Eleven of the chordomaswere subclassified as ‘conventional’ and one as ‘chondroid’; eight chondrosarcoma were ‘conventional’ andone was ‘myxoid’. Four chordoma patients underwent CT and MR ; in six, only MR was performed ; and in two, onlyCT. Eight chondrosarcoma patients underwent both CT and MR, while in one, only CT was performed. All scans wereretrospectively evaluated for the location(midline/off-midline), direction of extension, margin and shape, bonydestruction and calcification, MR signal intensity and enhancement patterns of the tumors. Degree of calcificationwas graded from I to III. Results : The epicenter of the mass of ten chordomas (83%) was midline, in twochondrosarcomas(22%), this was off-midline. Foci of calcification were observed in three of eleven chordomas(27%),and heavy calcification (grade III) was observed in one. In contrast to these findings, foci of calcificationswere observed in eight of nine chondrosarcomas (89%) and grade III calcification was observed in five. In bothtumors, calcification was coarse. Between the two kinds of tumor, there were no significant difference in MRsignal intensity and enhancement patterns, margin and shape, or direction of extension. Conclusions : Although MRand CT findings were similar in both types of tumor, location and degree of calcification may be features whichusefully distinguish chordoma from chondrosarcoma.

간종양:비전형적 전산화단층촬영(CT) 및 자기공명영상 (MRI) 소견

최국명 대한영상의학회 1997 대한영상의학회지 Vol.36 No.6

최근 영상진단기법의 발달과 함께 대부분의 비교적 흔한 간종양의 CT 및 MR 영상 소견은 잘 알려져 있다. 그러나 여러 종양들의 영상소견에는 상당한 중복이 있을 뿐만 아니 라 종양 자체의 잘 알려지지 않은 특이한 성질로 인하여 비전형적인 영상소견을 보일 수 있 어 진단에 어려움을 줄 수 있다. 이 임상화보에서는 간종양들의 CT 및 MR 영상들을 해석 할 때 당면하는 여러 진단적 함정과 비전형적인 소견들을 보여주고자 한다. The use of advanced imaging techniques in computed tomography (CT) and magnetic resonance imaging (MRI) has established the appearance of most common liver neoplasms. There are, however, considerable overlaps in the appearances of various pathologic entities on CT and MRI, and certain hepatic lesions can show unusual characteristics that may lead to misinterpretation, so it is important for the radiologist to be aware of these uncommon appearances. The purpose of this article is to illustrate the spectra of uncommon patterns and various diagnostic pitfalls encountered on CT and MRI of liver neoplasms.

고환수염전의 초음파소견

허정식,최국명 제주대학교 생명과학연구소 2002 제주생명과학연구 Vol.5 No.6

Purpose: Testicular pain or swelling, often referred to as the acute scrotum, can have a number of causes. Common cause of acute scrotal pain include testicular torsion, epidiymitis, testicular appendiceal torsion, and trauma. Color Doppler ultrasonography is being used increasingly in the evaluation of acute scrotum. Diagnostic accuracy is required to avoid the loss of testicular function in the case of testicular torsion and avoid unnecessary surgery in the other causes, we find the ultrasonographic finding of testicular appendiceal torsion. Materials and Methods: We retrospectively reviewed the hospital charts of 26 cases with acute scrotum who had been admitted to our hospital between January 1997 and November 2001 with the except of scrotal trauma. In the event of acute scrotum being suspected, an imaging study was performed. The 11 cases were evaluated with respect to accuracy of diagnosis and outcome of treatment. Results: The incidence of testicular appendiceal torsion was 46% of total acute scrotum boys. Torsion of either appendage produces pain similar to that experienced with testicular torsion. Color Dopper ultrasonography demonstrates increased bood flow of epididymis and secondary hydrocele. Conclusion: The cause of an acute scrotum can usually be established based on a careful history, a thorough physical examination and appropriate diagnostic test. When the history and clinical findings are equivocal. Color Doppler Ultrasonographic finding is usually able to differentiate testicular torsion, which is surgical emergency, from testicular appendiceal torsion which can be treated with conservative management.

여성호르몬대체요법을 받는 폐경 후 여성에서의 혈청 C-reactive Protein 수치 변화

황승욱,최국명 제주대학교 생명과학연구소 2002 제주생명과학연구 Vol.5 No.6

연구배경: 폐경 후 여성에서 여성호르몬 대체요법 치료는 관상동맥질환의 위험을 감소시킨다고 알려져 있지만 최근 발표된 연구에서는 기존에 관상동맥질환을 갖고 있는 폐경 후 여성에서 1년 내의 관상동맥질환의 위험이 증가했다가 시간경과에 따라 위험이 감수한다는 사실을 보여 주었다. 한편 혈청 C-reactive protein(CRP)의 등가는 광상동백질환의 독립적인 위험인자로 인정되고 있다. 이에 저자들은 여성호르몬 대체요법을 받는 폐경 후 여성을 대상으로 여성호르몬 대체요법이 혈청 CRP 수치의 변화와 관련성이 있는가를 알아보기 위해 본 연구를 시행하였다. 방법: 1995년 5월 1일부터 2001년 5월 31일까지 일개대학병원 건강증진센터에서 1년 정도의 간격으로 연속 3회 이상 건강검진을 받은 여성 188명 중에서 의무기록 열람과 전화조사를 통해 40세 이상 70세 미만으로 일개대학병원 가정의학과에서 처음으로 폐경 후 여성호르몬 대체요법을 받기 시작한 여성 40면을 대상으로 연도별로 혈중 CRP 수치의 변화를 분석하였다. 결과: 여성호르몬 대체요법 후의 혈중 CRP 농도는 고혈압 군에서 1년후의 CRP의 증가가 있었으나(P<0.05). 2년 후에는 기저수치에 비해 의미 있는 차이가 없었다. 비고혈압 군에서는 1년 후와 2년 후 모두 의미 있는 차이가 없었다. 결론: 본 연구에서는 특히 고혈압이 있으면서 폐경 후 여성호르몬대체요법을 받는 여성에서 시간적 경과에 따라 혈중 CRP 수치가 단기적으로 증가하였다가 점차 감소하는 경향을 보였다. Background: It was known that postmenopausal estrogen replacement therapy(ESP) decreased the risk of coronary heart disease. A recent study reported that the risk of coronary heart disease had a pattern of increase and decrease during ERT in postmenopausal women with coronary disease. The increase of Serum C reactive protein level was accepted as an independent risk factor of coronary heart disease. In this study, we tried to analyze the relationship between ERT in postmenopausal women and the change of CRP level. Methods: The study population was composed of 40 postmenopausal women who first started HRT in Health Promotion Center of University Hospital from May 5, 1995 to May 31, 2001. We checked their CRP level yearly. Results: In the group composed of postmenopausal women with hypertension, there was significant increase of CRP level(P<0.05) in 1 year ERT. But CRP level in 2 year after ERT was not significantly different from baseline level. In the group composed of postmenopausal women without hypertension. CRP level was not significantly changed 1 year after nor 2 year after. Conclusions: In this study, the CRP level showed the pattern of short-term increase and then decrease with time trend in postmenopausal women with hypertension.

소아 급성 충수염 진단에 초음파 내측 저에코선의 유용성

김봉수,최국명,김승형,박지강,김광식,강현욱,강기수 대한영상의학회 2007 대한영상의학회지 Vol.57 No.5

Purpose: We wanted to evaluate the usefulness of the inner hypoechoic band in pediatric appendices as an ultrasonographic criterion to exclude or confirm acute appendicitis. Materials and Methods: Among the 169 consecutive children with right lower abdominal pain, the 149 appendices depicted on US were prospectively evaluated for an inner hypoechoic band in the appendiceal walls. The sensitivity, specificity, positive and negative predictive values and accuracy were assessed for loss of the inner hypoechoic band as a diagnostic criterion for acute appendicitis. Results: The appendices in 12 (25%) patients with acute appendicitis show entire inner hypoechoic bands and those in 36 patients (75%) did not. The appendices in 97 (96%) patients without acute appendicitis showed entire inner hypoechoic bands, and those in 4 (4%) did not. The loss of inner hypoechoic band confirmed acute appendicitis with a sensitivity of 75%, a specificity of 96%, positive and negative predictive values of 89% and 90%, respectively, and an accuracy of 89%. The thickness of the inner hypoechoic band in patients without appendicitis was significantly higher than that in patients with appendicitis (p = 0.03). Conclusion: The visualization of entire thickened inner hypoechoic band in the appendiceal wall helps to rule out acute appendicitis. However, the loss of the inner hypoechoic band is suggestive of acute appendicitis. 목적: 소아에서 급성 충수염을 배제하거나 진단하는 기준으로써 충수 벽의 내측 저에코선이 유용한지를 알아보고자 하였다. 대상과 방법: 우 하복부 통증을 주소로 하여 초음파를 시행한 169명의 연속적인 환아들 중 충수를 발견할 수 있었던 149명을 대상으로 충수 벽의 내측 저에코선을 전향적으로 분석하였다. 내측 저에코선의 소실을 급성 충수염에 대한 진단기준으로 했을 때 민감도, 특이도, 양성예측도, 음성예측도 및 정확도를 구하였다. 결과: 급성 충수염이 있었던 환아의 12예(25%)에서 전장에 걸쳐 내측 저에코선이 보였고, 36예(75%)에서는 소실이 있었다. 반면, 급성 충수염이 없었던 환아 중 97예(96%)에서 전장에 걸쳐 내측 저에코선이 보였고, 단 4예(4%)만이 소실이 있었다. 급성 충수염을 진단하는 기준을 내측 저에코선의 소실로 했을 때 민감도 75%; 특이도 96%; 양성예측도 89%; 음성예측도 90%; 정확도 89%였다. 급성 충수염이 없었던 예의 내측 저에코선의 두께는 있었던 예보다 통계적으로 유의하게 두꺼웠다(p = 0.03). 결론: 우하복부 통증을 호소하는 환아의 초음파에서 충수 벽의 두꺼운 내측 저에코선이 전장에 걸쳐 관찰되는 것은 급성 충수염을 배제하는데 도움이 되었다. 그러나 내측 저에코선의 소실은 급성 충수염을 시사하는 소견이었다.

회음부에 위치한 다고환증 1례

허정식,최국명,김광식 제주대학교 생명과학기술혁신센터 2002 제주생명과학연구 Vol.5 No.-

Polyorchidism, defined as the presence of more than two testes, is a rare anomaly with approximately 98 cases reported in literature. We report the case of a 73-year-old man who had trichorchidism, two normal testes and one perineal testis, but he had not subjective symptom. All testes were normal in size and in shape. We have reviewed the literature.

Comparison of Three, Motion-Resistant MR Sequences on Hepatobiliary Phase for Gadoxetic Acid (Gd-EOB-DTPA)- Enhanced MR Imaging of the Liver

김두리,이정섭,최국명,김승형,고명주,송병철,이무숙,이경렬,고수연,김봉수 대한자기공명의과학회 2017 Investigative Magnetic Resonance Imaging Vol.21 No.2

Purpose: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. Materials and Methods: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-toliver contrast-to-noise ratio (CNR). The results were compared, using repeated posthoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. Results: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). Conclusion: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.

Cavernous Hemangioma of the Gallbladder: a Case Report

박재휘,이정섭,최국명,김봉수,김승형,김정재,김두리,현창림,허규희 대한자기공명의과학회 2019 Investigative Magnetic Resonance Imaging Vol.23 No.3

Cavernous hemangioma of the gallbladder is an extremely rare benign tumor. The tumor has only a few cases being reported in literature. However, to the best of our knowledge, no reports focusing on the MRI findings of cavernous hemangioma of the gallbladder have been published. This study reports a case of gallbladder hemangioma with pathologic and radiologic reviews, including MRI findings.

포스터 발표 : 미세변화증후군에서 합병된 신정맥 및 하대정맥 혈전증의 성공적인 혈전 용해술 1예

강우헌,김봉수,최국명 대한신장학회 2006 춘계학술대회 초록집 Vol.25 No.1