선천성 담도폐쇄증에서 99mTc DISIDA 신티그라피의 진단정확성 ( Diagnostic Accuracy of 99mTc-DISIDA 신티그라피의 진단정확성

현인영,이동수,이경한,김종호,정준기,서정기,이명철,고창순 ( In Young Hyun,Dong Soo Lee,Kyung Han Lee,Jong Ho Kim,June Key Chung,Jung Key Suh,Myung Chul Lee,Chang Soon Koh ) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3

We evaluated the diagnostic accuracy of 99mTc-DISIDA scintigraphy as a mean of differentianting biliary tresia from neonatal hepatitis. Tc-DISIDA scintigraphy was visually interpreted by assessing the presence or absence of radioactivity in the intestine or gall bladder. In patients without intestinal radioactivity, we measured the hepatic retention index and the hepatic uptake index. The hepat,ic retention index was expressed as the amount of change of liver activity from 5 minutes to 30 minutes postinjection. The hepatic uptake index was graded visually with 5 minute images using the following scoring scheme :grade 0(normal hepatic uptake), grade 1(decreased hepatic up take), grade 2(hepatic uptake equal to cardiac uptake), and grade 3(hepatic uptake less than cardiac uptake). Age, total bilirubin, and hepatic uptake index were compared between the biliary atresia and the neonatal hepatitis group, between neonatal hepatitis patients with and without intestinal radioactivity, and between the biliary atresia and neonatal hepatitis patients with absent int,estinal radioactivity. The results were as follows : l) None of the 30 hiliary atresia patients showed intestinal radioactivity, while 31/40 neonatal hepatitis patients showed intestinal radioactivity, The sensitivity, specificity, and accuracy of the presence of inlestinal radioactivity .or the diagnosis of biliary atresia was 100%, 78%, and 87%, respectively. 2) In patienis with absent intestinal radioactivity the mean hepatic retention index was 1.5+0.6 in the 16 biliary atresia patient,s, and 1.1+0.2 in the 7 neonatal hepatitis patients(p<0.01). All 7 patients with hepatic retention index over 1.5 had biliary atresia. But there were 9 patients with biliary at,resia below 1.5. 3) No significant differences were found in age, total bilirubin, or hepatic uptake index between biliary atresia and neonatal hepatit.is patients. However t.here were differences in age, total bilirubin, and hepatic uptake index bet.ween neonatal hepatitis patients with and without intestinal radioactivity. The hepatic upt,ake index was significantly lower, age was old, and total bilirubin was low in the group with intestinal radioact,ivity compared the group without intestinal radioactivity(p<0.05). Relation between total bilirubin and the hepatic uptake index was that total bilirubin was relatively low at normal hepatic uptake index in biliary atresia and neonatal hepatitis patients. 4) When hepatic uptake index and hepatic retention index were high it suggest that biliary atresia is more likely, considered relation between hepatic uptake index and the hepatic retention index. Thus, we conclude that Tc DISIDA scintigraphy is accurate in the differential diagnosis of biliary atresia and neonatal hepatitis. In patients without intestinal radioactivity, the hepatic retention index and hepatic uptake index, along with the patients age and total bilirubin level may supplement diagnosis and improve diagnostic accuracy.

급성 심근 경색 환자에서 재관류 후 조기에 시행한 휴식 / 24시간 지연 T1-201 심근 SPECT 의 심근벽 운동 호전 예측능

현인영,권준 ( In Young Hyun,June Kwan ) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.3

Purpose: We studied early rest/24 hour delay Tl-201 perfusion SPECT for prediction of wall motion improvement after reperfusion in patients with acute myocardial infarction. Materials and Methods: Among 17 patients (male/female ll/6, age: 59+13) with acute myocardial infarction, 15 patients were treated with percutaneous transcoronary angioplasty (direct:2, delay:11) and intravenous urokinase (2). Spontaneous resolution occurred in infarct-related arteries of 2 patients. We confirmed TIMI 3 flow of infarct-related artery after reperfusion in all patients with coronary angiography. We performed rest Tl-201 perfusion SPECT less then 6 hours after reperfusion and delay Tl-201 perfusion SPECT next day. Tl-201 uptake was visually graded as 4 point score from norrnal (0) to severe defect (3). Rest Tl-201 uptake <2 or combination of rest Tl-201 uptake<2 or late reversibility were considered to be viable. Myocardial wall motion was graded as 5 point score from normal (1) to dyskinesia (5). Myocardial wall motion was considered to be improved when a segment showed an improvement > 1 grade in follow up echo compared with the baseline values. Results: Among 98 segments with wall rnotion abnormality, the severity of myocardial wall motion decrease was as follow: mild hypokinesia: 18/98 (18%), severe hypokinesia: 28/98 (29%), akinesia: 5l/98 (52%), dyskinesia: 1/98 (1%), The wall rnotion improved in 85%. Redistribution (13%), and reverse redistribution (4%) were observed in 24 hour delay SPECT. Positive predictive value (PPV) and negative predictive value (NPV) of combination of late reversibility and rest Tl-201 uptake were 99%, and 54%. PPV and NPV of rest T1-201 uptake were 100% and 52% respectively. Predictive values of combination of rest Tl-201 uptake and late reversibility were not significantly different compared with predictive values of rest Tl-201 uptake only. Conclusion: We conclude that early Tl-201 perfusion SPECT predict myocardial wall motion improvement with excellent positive but relatively low negative predictive values in patients with acute myocardial infarction after reperfusion. (Korean J Nucl Med 1998;32:259-65)

Tc-99m MIBI and Tl-201 Uptake in a Thymic Carcinoma

현인영,Hyun, In-Young The Korea Society of Nuclear Medicine 2003 핵의학 분자영상 Vol.37 No.5

Tc-99m methoxyisobutylisonitrile (MIBI) and Tl-201/technetium subtraction scintigraphy have been used for localization of abnormal parathyroid gland. The uptake mechanism of tracers has been postulated to be increased cellular density and vascularity, or dependent on the presence of mitochondria-rich cells. However, the uptake of these tracers was not specific for abnormal parathyroid gland. The author report a case of thymic carcinoma that would have been mistaken for carcinoma of parathyroid because of Tc-99m MIBI and Tl-201 uptake.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간세포암에 대한 화학색전요법의 항종양 효과

현인영(In Young Hyun),이정애(Jung Ae Lee),고문수(Moon Soo Kih),은진호(Jin Ho Eun),염광섭(Kwang Seoup Yeoum),홍원선(Weon Seon Hong),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),변홍식(Hong Sik Byun),강숙욱(Sook Wook Kang),김기환(Kie Hwa 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1

N/A Eighty-seven TACEs were performed in 38 patients with hepatocellular carcinoma: one in 16 patients; twice in seven patients; three times in seven patients; four times in four patients; and five times in four patients. In all patients, TACE was performed with adriamycin, mitomycin-C and lipiodol. In 21 patients, embolization with gelfoam powders were added following TACE. Six patients had the hepatocellular carcinoma of 4.0~4.9 cm in diameter: 14 patients, 5.0~9.9 cm; and 18 patients, larger than 10 cm. Response rate was evaluated in 33 patients, among whom fifteen patients (45$) achieved response (complete response, 6%; partial response, 33%). The cumulative survival rates at one year and two years for 38 patients were 55.3$ and 23.2%, respectively, with the median survival time of 12.0 months. Sex, ascites, HBsAg, esophageal varix, liver cirrhosis, gelfoam embolization, serum albumin level, size of the tumor, and a-fetoprotein were analyzed to investigate the effect of TACE on survival time, demonstrating that no significant differences in the survival times were observed between these factors except HBsAg. Theses results suggest that TACE is not curable for hepatocellular carcinoma, however prolong the life span in patients with hepatocellular carcinoma.

흉부방사선치료후 발생된 심낭염 및 심근섬유화 1 예

김석균(Seog Gyun Kim),현인영(In Young Hyun),송재관(Jae Kwan Song),강윤구(Yoon Koo Kang),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),서정욱(Jeong Wook Seo) 대한내과학회 1989 대한내과학회지 Vol.37 No.5

N/A The heart was considered to be relatively resistant to ionizing radiation in the range of doses used in radiation therapy before systemic floolw up and review of a large number of patients who had undergone radiation therapy to the thorax and survived for at least several years. Various types of radiation-induced heart disease were reported and a clear dose response was evident for the degree and type of damage. In some settings, the heart has become recognized as the dose-limiting organ for radiation therapy directed to thoracic neoplasms and the tolerable dose may be further reduced by concomitant or sequential use of anticancer chemotherapeutic agents, especially doxorubicin (Adriamycin). In this article, we report e case of radiation-induced pericar-ditis and myocardial fibrosis in a patient with breast cancer who received postoperative adjuvant radiotherapy. A 43-year-old woman was admitted to the hospital because of progressive dyspnea and pitting edema. She underwent a simple mastectomy and axillary dissection due to left breast cancer (T2NIMO) in May 1979. After adjuvant radiotherapy for 1 1/2 months, she was followed up without further treatment and there was no evidence of local recurrence and systemic metastasis. In Aug. 1986, minimal pericardial effusion was noticed for the first time. Thereafter, exertional dyspnea developed and progressed slowly. In Dec. 1988, she suffered from cardiac tamponade and an emergency pericardiostomy was performed. The pericardial fluid was bloody but there was no evidence of local tumor invasion or granulomatous disease such as tuberculosis. Only extensive fibrosis of the parietal pericardium was observed, and also in that time, there was no other evidence of recurrence of breast cancer in spite of extensive work up. Under the impression of possible malignant effusion, tamoxifen (10 mg P.O. bid) was prescreibed but pericardial sclerosing therapy was not performed. After discharge, exertional dyspnea reappeared soon and abdominal distension with pitting edema was also noticed. Reaccumulation of massive pericardial effusion was confirmed by echocardiography and symptomatic treatment including diuretics was tried with improvement. In follow-up echocardiography done at OPD, pericardial effusion disappeared, but pulsating distension of the jugular vein and hepatomegaly were persistently observed. In Feb. 1989 she underwent confirmatory diagnostic procedures including cardiac catheterization and endomyocardial biopsy under the impression of radiation-induced heart disease. Cardiac catheterization revealed prominent y descent of right atrial pressure and equalization of right ventricular and left ventricular diastolic pressure. Histologic and electron microscopic examination of the endomyocardial biopsy showed moderate myocardial fibrosis and activation of endothelial cells which effaced some capillary lumens. Inflammatory changes were meager and there was no evidence of myocardial necrosis, which is consistent with a radiation effect. She is under OPD follow up with digitalis, captopril and small doses of the diuretics in functional class II of the New York Heart Association. Among various types of radiation-induced heart disease, chronic pericardial effusion in the cancer patient who received thorax radiation therapy is the most important to the attending physician. It should be deter-mined whether the pericardial effusion is due to invasion of malignancy or radiation therapy because the appropriate management is different, In some cases, constrictive pericarditis and myocardial fibrosis can develop after pericarditis, and cardiac catheterization and/or endomyocardial biopsy is required for correct diagnosis.

위암환자에서 복부 임파절 전이에 대한 초음파검사 및 전산화 단층촬영의 진단적 의의

김석균(Seok Kyun Kim),현인영(In Young Hyun),차중직(Joong Jik Cha),홍원선(Weon Seon Hong),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),백남선(Nam Sun Paik),김기환(Kie Hwan Kim),진수일(Soo Yil Chin) 대한내과학회 1990 대한내과학회지 Vol.39 No.2

N/A Preoperative findings of abdominal ultrasonography (US) and computed tomography (CT) were compared with the postoperative findings with special emphasis on abdominal lymphnode (LN) metastasis in patients with stomach cancer. The 98 patients' enrolled in this study had no evidence of LN and distant metastasis in preoperative abdominal US or CT and underwent operation from January, 1988 to December, 1988 in the Department of General Surgery III, Korea Cancer Center Hospital. Sixty-two (63%) of the 98 patients were confirmed to have LN metastasis in the postoperative pathologic examination: 62%, in 50 patients without LN metastasis in preoperative US and 65%, in 48 patients without LN metastasis in preoperative CT. The senstivity of US was similar to that of CT in predicting LN metastasis. We analyzed the effects of age, sex, abdominal pain, performance status, Borrmann type and size of the tumor on the predictability of LN metastasis, demonstrating that no significant relation- ship was found between these factors and LN metastasis except for the size of the tumor. In patients with a tumor less than 2 cm in diameter, LN metastasis was found in 25%(N1, N2, 0%); in 2-4 cm, 53% (N1, 47%, N2, 6%); in 4-6 cm, 79%(N1 62%, N2 17%); in 6-8 cm, 92% (N1 84%, N2 8%); in more than 8 cm, 839p (N1 66%, N2 17%). The incidence of early gastric cancer (EGC), diagnosed by postoperative pathologic findings, was significantly higher in small-sized tumors compared to the large-sized tumors (p<0.01): in less than 2 cm, 0%. Staging of stomach cancer was performed according to TNM staging grouping approved by UICC and AJC in 1985. The stage showed a progress with the increase in size of the tumor (p<0.01). In less than 2 cm, stage I, II, III and IV were 68, 7, 25and 0%, respectively. In 2-4 cm, stage I, II, IIIand IV were 26, 18.53and 3%, respectively. In 4-6 cm, stage I, II, IIIand IV were 8, 16, 56and 20%, respectively. In 6-H cm, stage I, II, IIIand IV were 0, 15, 75and 15%, respectively. In more than 8 cm, stage I, II, IIIand IV were 0, 0, 50and 50%, respectively. These results suggest that abdominal LN metastasis can not be predicted by US or CT alone. However, dy the addition of size of the tumor to US or CT findings, the predictability of LY, metastasis can be significantly increased in stomach cancer patients.

원발성 악성 골양종의 99mTc - MDP 골스캔 소견

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),현인영(In Young Hyun),강흥식(Heung Sik Kang),이경한(Kung Han Lee),이상훈(Sang Hoon Lee),이한구(Han Koo Lee) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.1

N/A Tc-99m-MDP bone scan was performed in 31 patients with primary malignant bone tumors, 22 patients with osteogenic sarcoma, 5 patients with chondrosarcoma and 4 patients with Ewing's sarcoma. The findings were classified by isotope intensity of accumulation in tumor as grade 1 to 3, overall pattern of isotope distribution in tumor as grade 1 to 3, and distortion of bony outline as grade 1 to 3. Histologic classifications were correlated with scan findings in 22 patients with osteogenic sarcoma. The results were as follows. 1) In 22 patients with osteogenic sarcoma, markedly increased isotope intensity higher than sacroiliac joint with patchy areas of decreased intensity and severe bony distortion were found in 16 patients. The correlations between histologic classification and scan findings were not discovered. 2) In 5 patients with chondrosarcoma, mildly increased isotope intensity with patchy areas of increased intensity and mild bony distortion were found in 4 patients. 3) In 4 patients with Ewing's sarcoma, markedly increased homogenous intensity with moderate bony distortion were found in 3 patients. Conclusively there were common findings in each 3 primary malignant bone tumors and Tc-99m-MDP bone scan was complemented with radiologic studies in differentiating primary malignant bone tumors.

신피질성 간질에서 발작기 99mTc - HMPAO 뇌혈류 SPECT의 간질병소 국소화 성능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),김은실(Eun Sil Kim),현인영(In Young Hyun),장기현(Kee Hyun Chang),이상건(Sang Kun Lee) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.4

N/A The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography (sEEG). Ictal Tc-99m-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewd. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MR1, ictal SPECT found zones of hyperperfusion concordant with ictal sEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

악성 종양의 추적 관찰 중 PET-CT에서 발견된 갑상선의 우연종

김중석,최소영,노효근,김세중,김윤정<SUP>1<,SUP>,현인영<SUP>2<,SUP>,김영모<SUP>3<,SUP>,조영업,Joong Suck Kim,M,D,So-young Choi,M,D,Ph,D,Hyo Keun No,M,D,Sei Joong Kim,M,D,Ph,D,Youn Jeong Kim,M,D,Ph,D,<SUP>1<,SUP>,In Young Hyun 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: The incidence of thyroid cancer is increasing in Korea, partially owing to the development of diagnostic tools. Positron emission tomography (PET)-computed tomography (CT), in particular, has generally been used for evaluation of metastasis and follow-up of malignancy. Methods: We retrospectively investigated 2,833 patients with PET-CT for metastasis work-up or cancer follow-up, which was performed between January 1998 and May 2008 at Inha University Hospital. Of them, abnormal thyroid findings were discovered in 181 patients and we studied the result of further evaluation or follow-up PET-CT. Results: Thyroid cancer was diagnosed in 26 patients, including metastatic cancer in 3 patients, and non-operated primary cancer in 2 patients. Other 21 patients received operation, which in all histopathologically revealed papillary carcinoma. The mean age of the 21 patients was 55.4 years. Nine patients had a history of radiotherapy. The site of malignant nodule was discordant between PET-CT and histopathologic result in 6 patients. The mean size of malignant nodules was 9.45 mm (0.1∼23 mm) with microcarcinoma in 10 patients (47.6%). The mean interval between diagnoses was 15.8 months, and in 4 patients operations for two malignancies were performed in a same day. The incidence of thyroid cancer was significantly high in female patients, but the differences of incidence among different cancer groups were not significant for female patients. Conclusion: Early diagnosis of synchronous or secondary thyroid cancer by PET-CT in cancer patients can make early treatment and better strategies for multiple malignancies possible. (Korean J Endocrine Surg 2010;10:249-255)

위식도 역류와 폐 흡인 진단 방법으로서 위식도 역류 신티그래피의 유용성

강성길,현인영,임대현,김정희,손병관,Kang, Sung-Kil,Hyun, In-Young,Lim, Dae-Hyun,Kim, Jeong-Hee,Son, Byong-Kwan 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.1

목 적: 영유아에서 위식도 역류는 흔한 질환이며, 위식도 역류의 합병증으로 위 내용물의 폐 흡인에 의한 만성 호흡기 질환이 생길 수 있으나 이를 진단하기 위한 표준적인 검사 방법이 없다. 본 연구에서는 위식도 역류와 폐 흡인 진단 방법으로서 위식도 역류 신티그래피의 유용성을 평가하고자 하였다. 방 법: 위식도 역류로 인한 흡인 폐렴이 의심된 35명의 환아와 정상 대조군 5명을 대상으로 하였다. 모든 대상아에게 $^{99m}Tc$-tin colloid를 첨가한 우유를 수유한 후 위식도 역류 신티그래피를 시행하였다. 위식도 역류를 진단하기 위해 1시간 동안 동적 영상을 촬영하였고, 폐 흡인을 진단하기 위해 6시간과 24시간 후 지연 영상으로 정적 영상을 얻었다. 폐 흡인의 진단을 위해 육안분석과 함께 양쪽 폐에 관심 영역을 설정하여 정량 분석을 시행하였다. 흡인 지수는 관심 영역에서 배경 영역의 계수치를 뺀 값으로 정의하였다. 결 과: 35명의 환아 중 23명에서 신티그래피상 위식도 역류가 관찰되었고, 정상 대조군 5명에서는 위식도 역류가 발견되지 않았다. 환아군 35명 중 24명에게 24시간 하부 식도 pH 검사를 시행하였고, 7명에서 산성역류가 확인되었다. 신티그래피와 하부 식도 pH 검사를 동시에 받은 24명 중 8명에서 두 검사의 결과가 일치하여 두 검사는 위식도 역류의 진단에 있어 일치하지 않았다. 환아군 35명 중 16명에게 흉부 전산화 단층 촬영을 시행하여 13명의 환아에서 의존성 위치에 폐 경화가 발견되어 흡인 폐렴으로 진단하였고, 이 환아들이 신티그래피에서도 폐 흡인이 있었는지 그 일치도를 알아보았을 때, 두 검사는 폐 흡인의 진단에 있어 일치하지 않았다. 한 명의 환아에서 6시간 후 지연 영상에 우폐로 역류된 방사능이 육안적으로 관찰되었다. 대조군과 비교하였을 때, 30명(85.7%)의 환아에서 흡인 지수가 결정점인 0.3보다 높아 폐 흡인의 가능성이 높은 것으로 진단하였다. 역류군과 비 역류군을 비교하였을 때, 6시간 후 지연 영상에서 흡인 지수는 역류군에서 유의하게 높았다(p<0.05). 결 론: 위식도 역류 신티그래피는 비 침습적이고 안전한 검사로 위식도 역류의 진단에 있어서는 24시간 하부 식도 pH 검사에 비하여 부족하지만 역류로 인한 소량의 폐 흡인을 진단하는데 유용하며, 앞으로 통계학적으로 의미 있는 수의 대조군 연구가 수행된다면 폐 흡인을 확진할 수 있는 진단 기준이 나올 것으로 생각된다. Purpose: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. Methods: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a $^{99m}Tc$-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. Results: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). Conclusion: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.