• 대한두경부종양학회지
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• 제14권2호
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• pp.228-235
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• 1998

Objectives: Papillary microcarcinoma of the thyroid was evaluated as to the effectiveness of diagnostic modalities, lymphatic spread pattern, and therapeutic decision according to tumor size. Material and Methods: We retrospectively analyzed a clinicopathologic findings of 72 papillary microcarcinoma patients who were treated at the over 11 years between 1985 and 1995. The authors divided papillary microcarcinoma of the thyroid into two subgroups according to tumor size: $0{\leqq}5mm$ and $5<0{\leqq}10mm$. An analysis including age and gender distribution, diagnostic tools(thyroid sonogram, thyroid scan, thyroid function test, fine needle aspiration cytology, frozen section), pathological examination of lymphnode, and surgical procedures was carried out in each subgroups. Results: The carcinoma of smaller than 5mm were found in 32 patients, and of 6 -10mm were in 40 patients. The average age of patients was 45years and all of them were female. Cold nodules on thyroid scan were noticed in 53 patientss and normal findings were in 15 patients. Suspicious malignant lesions(fine calcification, solid mass, irregular margin) on thyroid sonography were detected in 23 patients and the sonography was more useful in detecting $0{\leqq}5mm$ small sized lesions than other diagnostic methods. FNAC were performed in 17 patients, and 7 patients were diagnosed as having thyroid papillary cancer. But diagnotic rate in $0{\leqq}5mm$ small sized lesions was very low(one of eights).Frozen section were performed in all patients, among these 15 patients were diagnosed as being benign diseases and false negative rates were higher in $0{\leqq}5mm$ small sized lesions than in $5<0{\leqq}10mm$ sized lesions(p-value<0.006). Only thyroidectomies were performed in 24 patients and thyroidectomy with node dissections in 48 patients. The lymphnode metastatic rates were much higher in multifocal lesions(61.5%) than in single lesion. The incidence of cervical lymphnode metastasis was 19.4% in $0{\leqq}5mm$ sized lesions and 47.9% in $5<0{\leqq}10mm$ sized lesions. Postoperative management were performed with TSH suppression therapy(T4, synthroid) in all patients and RI therapy in 29 patients. Conclusion: On the basis of our study, improved preoperative diagnostic tools for papillary microcarcinoma of the thyroid was helpful in the choice of surgical treatment. As a result of techninological progress(ultrasonography, FNAC), the pencentage of the discovery of papillary microcarcinoma has been increased. The thyroid ultrasonography was useful in detecting small sized lesions($0{\leqq}5mm$), but FNAC may not be beneficial in detecting small sized lesions($0{\leqq}5mm$). In the surgical procedure, thyroid lobectomy alone should be avoided because of the high rate of bilaterality and multifocality.

• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.87-93
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• 1985

1983년 5월부터 1985년 11월까지 영남대학교 의과대학 부속병원에서 복부농양을 의심하여 초음파검사를 시행후 확진된 48명의 환자에서 초음파소견을 분석하여 다음과 같은 결과를 얻었다. 1) 농양의 위치는 복강내 농양이 30예, 내장 농양이 13예, 후북막강농양이 5예였다. 2) 원인별로는 복강내 농양의 25예는 충수돌기염에 의하였고. 5예는 수술후 합병증으로 생겼다. 후복막강농양 5예는 전부 요근농양으로, 결핵성 및 화농성이 각각 2예, 후복막강에 위치한 충수돌기 염증이 1예였다. 내장농양은 12예가 간농양으로 이 중 9예는 화농성, 3예는 아메바성이었고 췌장염에 의한 췌장미부농양이 l예였다. 3) 형태는 총 48예중 26예(54%)에서 구형 또는 난원형이었으며, 특히 내장농양이 복강내 농양에 비해 구형 또는 난원형이 많았다. 4) 병변의 크기는 26예(54%)에서 5~10cm사이였으며, 내부echo는 33예(69%)에서 낭포성이었다.

• Investigative Magnetic Resonance Imaging
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• 제19권4호
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• pp.231-236
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• 2015

A 17-year-old girl presented with complaints of headache and decreasing vision of one month's duration, without any history of fever, weight loss, or any evidence of an immuno-compromised state. Her neurological examination was normal, except for papilledema. Laboratory investigations were within normal limits, except for a slightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerized tomography of her head revealed complex mass in left frontal lobe with a concentric, slightly hyperdense, thickened wall, and moderate perilesional edema with mass effect. Differential diagnoses considered in this case were pilocytic astrocytoma, metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla (3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe with two concentric layers of T2 hypointense wall, with T2 hyperintensity between the concentric ring. Moderate perilesional edema and mass effect were seen. Post gadolinium study showed a markedly enhancing irregular wall with some enhancing nodular solid component. No restricted diffusion was seen in this mass in diffusion weighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increased lactate and lipid peaks in the central part of this mass, although some areas at the wall and perilesional T2 hyperintensity showed an increased choline peak without significant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease in relative cerebral blood volume at this region. These features in MRI were suggestive of brain abscess. The patient underwent craniotomy with excision of a grayish nodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioid cell granulomas, caseation necrosis and Langhans giant cells in histopathology, were conclusive of tubercular abscess. Tubercular brain abscess is a rare manifestation that simulates malignancy and cause diagnostic dilemma. MRI along with MRS and magnetic resonance perfusion studies, are powerful tools to differentiate lesions in such equivocal cases.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.56-59
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• 2003

구강악안면 영역에서의 외상에 의한 내악 동맥의 가성 동맥류는 극히 드문 병변으로 저자들은 서울 대학교 치과병원 구강악안면외과에서 1례를 치험하였다. 그 원인은 외상에 의한 하악 과두 골절, 관혈적 정복술시의 의원적 외상 또는 둘 다를 고려해 볼 수 있었으며 임상적으로 박동성 잡음,촉진 가능한 맥동이 있었고 술중 과다 출혈의 양상을 보였다. 병소는 혈관 조영술에 의해 확진되었으며, 색전술로 치료하였다. 가성 동맥류는 생명을 위협할 정도의 과다 출혈을 일으킬 수 있으므로 그 진단과 치료는 중요하다. 혈관 조영술은 임상적 증상에 대한 확실한 진단을 가능케 해 주며 이를 이용한 색전술은 관혈적 결찰법에 비해 장점을 가지므로 좋은 치료법이 될 수 있다.

• Investigative Magnetic Resonance Imaging
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• 제2권1호
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• pp.104-112
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• 1998

목적 : 다양한 두개강내 질환을 가진 환자들을 대상으로 확산강조영상을 시행하여 병변의 신호강도를 분석함으로써 확산강조영상의 임상적 유용성을 알아보고자 하였다. 대상 및 방법 : 전향적으로 무작위 추출하여 확산강조영상을 시행한 70명의 환자(급성 뇌경색 20명, 만성 뇌경색 또는 소혈관 질환 21명, 두개강내 원발성 종양 14명, 뇌전이 3명, 뇌종양 5명, 뇌혈종 5명, 퇴행중의 유구낭미충 1명, 유피낭종 1명)를 대상으로 하였다. 확산강조영상은 1.5T 장치를 사용하여, single shot spin echo EPI 기법을 사용하여, 6500ms TR, 107ms TE, $128{\times}128$ matrix, 1 number of excitation, $24{\times}24{\;}cm$ field of view, 5-7mm slice thickness, 2-3 mm inter-slice gap으로, x, y, z 세방향으로 확산경사자기($b=1000s{\;}/{\;}textrm{mm}^2$)를 가하여 얻었다. 병변의 신호강도의 평가는 정성적인 분석에서는 병변의 신호강도를 임의의 5단계로 구분하여 분석하였고, 정량적 분석에서는 ROI(region of interest)를 이요하여 병변의 신호강도를 측정하여, 반대쪽 정상 뇌실질에서 얻은 신호강도와의 상대적 신호강도비를 구하였다. 결과 : 정성적 분석에서 매우 높은 신호강도를 보인 병변은 모든 예의 급성 뇌경색, 뇌농양, 유피낭종, 그리고 퇴행성 유구낭미충의 낭성 병변이었다. 뇌혈종은 모든 예에서 병변내에 매우 높은 신호강도와 낮은 신호강도가 혼재되어 있었다. 1명의 종양환자에서는 고형성 부분에 국소적인 매우 높은 신호강도가 보였다. 이들 병변 각각의 뇌실질에 대한 평균 신호 강도비는 모두 2.5 이상이엇다. 정성적 분석에서 죄실질과 같은 정도의 신호강도를 보인 경우는 실경교증(71%), 뇌종양의 고형성 부분(64%), 뇌전이 (100%), 혈관성 부종(67%)이었으며, 이들 병변의 뇌실질에 대한 평균 신호강도비는 1.15에서 1.28로 서로간에 의미있는 차이는 없었다.(p>0.1). 매우 낮거나 약간 낮은 신호강도를 보인 경우는 낭성 뇌연화증과 종양내 괴사로서, 평균 신호강도비는 각각 0.45와 0.42였다. 결론 : 급성 뇌경색, 뇌농양, 유피낭종, 퇴행중의 유구낭미충은 확산강조영상에서 매우 높은 신호강도를 보여, 다른 실환과의 감별 진단에 유용할 것으로 생각되며, 특히 뇌농양과 괴사나 낭성 부분을 포함한 뇌종양과의 감별에 많은 도움이 될 것으로 기대된다.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.289-293
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• 2001

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9487-9494
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• 2014

Background: The size of a hepatic neoplasm is critical for staging, prognosis and selection of appropriate treatment. Our study aimed to compare the radiological size of solid hepatocellular carcinoma (HCC) masses on magnetic resonance imaging (MRI) with the pathological size in a Chinese population, and to elucidate discrepancies. Materials and Methods: A total of 178 consecutive patients diagnosed with HCC who underwent curative hepatic resection after enhanced MRI between July 2010 and October 2013 were retrospectively identified and analyzed. Pathological data of the whole removed tumors wereassessed and differences between radiological and pathological tumor size were identified. All patients were restaged using a modified Tumor-Node-Metastasis (TNM) staging system postoperatively according to the maximum diameter alteration. The lesions were classified as hypo-staged, iso-staged or hyper-staged for qualitative assessment. In the quantitative analysis, the relative pre and postoperative tumor size contrast ratio ($%{\Delta}size$) was also computed according to size intervals. In addition, the relationship between radiological and pathological tumor diameter variation and histologic grade was analyzed. Results: Pathological examination showed 85 (47.8%) patients were overestimated, 82 (46.1%) patients underestimated, while accurate measurement by MRI was found in 11 (6.2%) patients. Among the total subjects, 14 (7.9%) patients were hypo-staged and 15 (8.4%) were hyper-staged post-operatively. Accuracy of MRI for calculation and characterized staging was related to the lesion size, ranging from 83.1% to 87.4% (<2cm to ${\geq}5cm$, p=0.328) and from 62.5% to 89.1% (cT1 to cT4, p=0.006), respectively. Overall, MRI misjudged pathological size by 6.0 mm (p=0.588 ), and the greatest difference was observed in tumors <2cm (3.6 mm, $%{\Delta}size=16.9%$, p=0.028). No statistically significant difference was observed for moderately differentiated HCC (5.5mm, p=0.781). However, for well differentiated and poorly differentiated cases, radiographic tumor maximum diameter was significantly larger than the pathological maximum diameter by 3.15 mm and underestimated by 4.51 mm, respectively (p=0.034 and 0.020). Conclusions: A preoperative HCC tumor size measurement using MRI can provide relatively acceptable accuracy but may give rise to discrepancy in tumors in a certain size range or histologic grade. In pathological well differentiated subjects, the pathological tumor size was significantly overestimated, but underestimated in poorly differentiated HCC. The difference between radiological and pathological tumor size was greatest for tumors <2 cm. For some HCC patients, the size difference may have implications for the decision of resection, transplantation, ablation, or arterially directed therapy, and should be considered in staging or selecting the appropriate treatment tactics.

• Investigative Magnetic Resonance Imaging
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• 제17권4호
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• pp.286-293
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• 2013

목적 : 본 연구는 20대 건강한 성인을 대상으로 반전 시간 (inversion time, TI)의 차이에 의한 뇌 영상을 획득하여 체적을 분석하였다. 대상 및 방법 : 20대 건강한 성인을 대상으로 MPRAGE (magnetization prepared rapid acquisition gradient echo) pulse sequence, 절편두께 1.5 mm, 4개의 반전 시간 (800 ms, 900 ms, 1000 ms, 1100 ms)을 이용해 뇌 영상을 획득하였다. 획득된 뇌 영상을 이용해 백질 (white matter, WM), 회백질(gray matter, GM), 그리고 전체 뇌 체적(intracranial volume, ICV)을 측정하고 각 TI 별로 뇌 체적 및 성별에 따른 통계적인 차이가 있는지 분석하였다. 결과 : Freesurfer로 산출된 뇌 체적은 평균 ICV=$1278.94{\pm}154.92cm^3$를 이용하여 정규화 하였고, 평균 WM=$486.52{\pm}48.64cm^3$, 평균 GM=$646.83{\pm}57.12cm^3$ 이었다. 남자의 뇌 체적 (WM, GM, ICV)은 여자보다 컸다. 측정간 신뢰도 테스트에서 급내 상관 계수는 모두 높은 수치를 나타내었다 (WM 0.992, GM 0.988, ICV 0.997). 반복측정 분산분석에서는 GM과 ICV는 각 TI에서 유의수준 내에서의 차이가 없었지만 (GM p=0.143, ICV p=0.052) WM는 유의수준 내에서의 차이가 있었다 (p=0.001). 선형 구조 관계 분석에서는 피어슨 상관 계수가 모두 높은 수치를 보였다. 결론 : WM, GM, ICV는 높은 신뢰도와 선형 구조 관계를 나타내었고 WM는 각 TI에서 유의수준 내에서의 차이를 보였다. 20대 건강한 성인의 뇌 체적의 자료는 환자들과의 비교에 참고자료로 사용될 수 있을 것이며, 뇌의 구조적인 변화를 예측하는데 도움을 줄 것이다. TI의 변화에 따라 대조도, 잡음비 그리고 병변의 검출 능력을 조사하는 추가적인 연구가 필요할 것이다.

• 대한방사선치료학회지
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• 제16권2호
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• pp.19-24
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• 2004

목적 : Pelvis내에 존재하는 large lesion과 inguinal lymph node를 동시에 치료하고자 할때 femoral head에 과도한 선량을 피할 목적으로 partial transmission block(이하PTB)이 사용되어져 왔다. 그러나 field가 서로 overlap되거나 분리되는 문제를 해결하기 위한 다소 복잡하고 시간도 많이 걸리는 어려움이 있어 본 논문에서는 real block과 MLC를 이용하여 각각 PTB를 제작한 후 몇 가지 비교를 통하여 두 가지 중 실제 임상에 더 효율적으로 사용할 수 있는 방법을 연구하였다. 대상 및 방법 : 실제 치료 환자를 대상으로 디자인 된 PTB를 real block과 MLC를 이용하여 각각 제작한 뒤 아크릴 phantom으로 환자의 두께를 재현하고 치료 시와 동일한 조건으로 노광된 film을 획득하였다. field간에 overlap되는 부분과 분리되는 부분은 block을 미세 조장한 후 다시 촬영하였으며 오차가 1mm이내에 들어 올때까지 junction을 반복 tuning하였다. 두 block을 재현성, 제작 편의성, 제작 시간으로 나누어 비료 분석하였다. 재현성은 5회 반복 측정을 실시하였으며, 제작 편의성 및 제작 시간은 real block과 MLC가 각각 제작 시작 시간부터 완성되는 시점까지에 대하여 측정하였다. 결과 : PTB를 제작함에 있어서 real block과 MLC는 재현성 면에서는 유의할 만한 차이를 보이지 않았다. 그러나 제작 편의성에 있어서는 MLC가 junction tuning을 더 간편하게 수행 할 수 있었으며, 제작 시간 면에 있어서도 MLC가 real block에 비해 약$33\%$정도의 시간 절감 효과가 있음을 알 수 있었다. 결론 : PTB를 제작함에 있어서 real block과 MLC를 이용하는 것이 각각 장단점을 가지고 있으나 real block은 제작 편의성면에서 유연서이 떨어짐으로 각 fie의 junction을 tuning하는데 매우 어려움이 따름과 동시에 비교적 정확한 junction tuning을 시행할 수 있음을 알수 있었다. MLC특성상 발생되는 계단형태의 junction을 보완하여 PTB를 제작한다면 실제 임상에서 훨씬 간편하고 효율성 있는 업무를 수행할 수 있을 것으로 사료된다.