• Title/Summary/Keyword: evaluation tool

검색결과 3,639건 처리시간 0.038초

어머니가 지각한 영아기질과 어머니 역할수행에 대한 자신감 및 만족도의 관계 (Relationship of Maternal Perception of the Infant Temperament and Confidence and Satisfaction of Maternal Role)

  • 이영은;강양희;박혜선;황은주;문미영
    • Child Health Nursing Research
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    • 제9권2호
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    • pp.206-220
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    • 2003
  • Purpose: this study was intended to search the relationship between perception of the infant temperament in mother of infant at the age of 1~12 months and maternal confidence and satisfaction in performing maternal role, and to submit a basic data to establish a nursing intervention program which is helpful for determination of infant development and performing maternal role promotion by identify variables associated with infant temperament. Method: The subjects of this study were 300 mothers of infant at the age of 1~12 months who visited well baby clinic in 4 hospitals in Busan city and Kyoung-Nam province. Final analysis was performed in 293 cases. Seven cases was excluded in this study because of its inappropriate data collection. The data was collected from 1st July to 15th August 2002. The questionaries which were fill-up by mother were collected. Infant temperament was measured by using the tool of 'what my baby is like'(WBL) which was developed by Priham et. al.(1994) and translated by Bang(1999). The scale of postpartum self evaluation which was developed by Lederman et al(1981) and translated by Lee(1992) was used for the confidence and satisfaction of maternal role. All statistical analyses were performed using SPSS-PC for window, version 10.0: frequency, percentage, minimum, maximum, mean, SD, t-test, ANOVA, Post-hoc test(Scheffe's test), Pearson Correlation Coefficients. Result: The mean score of maternal perception of the infant temperament was 6.17±1.04, and mother recognized her infant as positive. The mean score of confidence of maternal role was 2.89± .41 and this revealed in an average level. The mean score of satisfaction of maternal role was 3.29± .51 and this revealed in a higher level. There was a weak significant positive correlation between the score of maternal perception of infant temperament and confidence of maternal role(r=0.176, P= .003), but there was no significant correlation between satisfaction of maternal role(P> .05). It revealed the more maternal perception of the infant temperament as positive, the higher confidence of maternal role. There was a moderate significant positive correlation between confidence of maternal role and satisfaction of maternal role(r=0.410, P= .000). It revealed the more confidence of maternal role, the higher satisfaction of maternal role. The variables related with the score of maternal perception of infant temperament were the type of delivery (t=-2.600, P= .010), experience of learning baby care(t=2.382, P= .018), maternal perception on baby's health status(F=3.467, P= .033), maternal perception on her health status(F=3.467, P= .027), baby's age(F=3.080, P= .028). Conclusion: Our result showed the confidence of maternal role was increased as the maternal perception of infant temperament was positive, and conformed that the confidence of maternal role was also related with satisfaction of maternal role. Prenatal education, type of delivery, baby's age were also related with the maternal perception of infant temperament. So, nursing intervention program of developmental stage maybe necessary in order to help maternal perception of infant temperament as positive, and it will be increased the confidence of maternal role and satisfaction of performing maternal role which was considered as real indicate of achievement of maternal role.

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대학교 재학생에서 Fatigue Severity Scale의 신뢰도 및 타당도 연구 (Reliability and Validity of the Fatigue Severity Scale among University Student in South Korea)

  • 이정현;정현석;임수미;조한별;마지영;고은;임주연;이선혜;배수진;이유진;류인균;정도언
    • 생물정신의학
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    • 제20권1호
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    • pp.6-11
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    • 2013
  • Objectives There are only a limited number of studies on instruments assessing fatigue in university students, although fatigue exerts negative influences on their health and academic performances and fatigue-related complaints are more frequently reported in young adults than middle-aged adults. The aim of this study was to validate the 9-item Fatigue Severity Scale (FSS) among university students including both undergraduate and graduate students in South Korea. Methods A total of 176 university students completed a battery of self-report questionnaires, including the FSS, the Brief Fatigue Inventory (BFI), the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), the Medical Outcomes Study Short Form 36 version 2 (MOS-SF36v2), and the Inclusion of Community in the Self Scale (ICS). The data were collected from February of 2012 to June of 2012. The reliability, convergent validity, divergent validity, and exploratory factor analyses were conducted to assess psychometric properties of the FSS. Results The mean FSS score was 3.20 (standard deviation = 1.43). The FSS demonstrated an excellent internal consistency (Cronbach's ${\alpha}$ = 0.93) and item-total correlations ranged from 0.56 to 0.90. Correlations of the FSS with the BFI (r = 0.71, p < 0.01), BDI-II (r = 0.54, p < 0.01), BAI (r = 0.46, p < 0.01), MOS-SF36v2 physical component summary (r = -0.28, p < 0.01), MOS-SF36v2 mental component summary (r = -0.55, p < 0.01), and ICS (Spearman's rho = -0.07, p = 0.33) showed acceptable convergent and divergent validity. Exploratory factor analysis defined one underlying factor (eigenvalue = 5.67) that explained 93.50% of the total variance. Conclusions To the best of our knowledge, this is the first study to investigate reliability and validity of the FSS in university students. The FSS exhibits good psychometric properties for evaluation of fatigue among university students in South Korea. Since the FSS is easy to administer, score, and interpret, it could be a useful tool in research and practice for assessing fatigue among university students.

유한요소법을 이용한 나이티놀 와이어 스텐트의 전산모사 실험 데이터 검증 (The Verification of Computer Simulation of Nitinol Wire Stent Using Finite Element Analysis)

  • 김진영;정원균;전동민;신일균;김한기;신동오;김상호;서태석
    • 한국의학물리학회지:의학물리
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    • 제20권3호
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    • pp.139-144
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    • 2009
  • 최근 스텐트 시술의 수학적인 분석은 스텐트의 위치와 기계적인 반응을 측정하는 여러 가지 툴이 개발됨에 따라 발전하고 있다. 그러나 기존의 연구의 경우, 전산모사 실험을 통해 여러 요소에 따른 변형 정도 및 응력 분포, 팽창력 등과 같은 성능평가에 대한 연구가 주류를 이루며 전산모사 실험을 통한 응력 분포 및 변형 정도에 대한 소프트웨어의 검증은 거의 없는 실정이다. 따라서 본 연구에서는 만능재료 시험기를 이용한 실험을 통해 얻은 결과와 전산모사 실험 결과의 유의성 검증을 통해 해당 전산 모사용 소프트웨어를 통한 전산모사 실험 결과에 신뢰성을 부여하였다. 또한 이를 토대로 전산모사 실험을 통해 스텐트 피막 유무에 따른 스텐트의 응력분포를 분석하고자 하였다. 본 연구에서는 전산모사 실험 데이터와 실제 인장 시험 데이터를 통한 유의성 검증을 하고자 하였다. 스텐트의 연결 부분에 대해 유한요소 해석법을 적용하여 전산모사 실험을 수행한 결과, 178.93 MPa의 최대응력으로 인장시험 결과인 184.23 MPa와 거의 유사한 값을 가졌으며, 이를 통해 인장시험 결과와 전산모사 결과가 유의성을 가짐을 검증할 수 있었다. 또한 피막 유무에 따른 스텐트의 전산모사 실험을 통해 피막에서는 접촉부, 나이티놀에서는 연결부에서 최대 응력이 발생함을 알 수 있었다. 그리고 피막이 있는 경우에는 피막의 장력으로 인해 연결부분에서 형상을 유지하고 있으나 피막이 없는 경우에는 이격 및 교차부에서 슬립이 발생함을 알 수 있었다. 이러한 결과들을 통해 스텐트 설계 초기에 있어 해당 전산모사용 소프트웨어를 통해 해석을 수행하여 그에 따른 해석 결과를 설계에 반영함으로써 설계 변경을 최소화할 수 있고, 이에 따라 양질의 설계 품질 확보가 가능할 것으로 사료된다.

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A Study on groundwater and pollutant recharge in urban area: use of hydrochemical data

  • Lee, Ju-Hee;Kwon, Jang-Soon;Yun, Seong-Taek;Chae, Gi-Tak;Park, Seong-Sook
    • 한국지하수토양환경학회:학술대회논문집
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    • 한국지하수토양환경학회 2004년도 임시총회 및 추계학술발표회
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    • pp.119-120
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    • 2004
  • Urban groundwater has a unique hydrologic system because of the complex surface and subsurface infrastructures such as deep foundation of many high buildings, subway systems, and sewers and public water supply systems. It generally has been considered that increased surface impermeability reduces the amount of groundwater recharge. On the other hand, leaks from sewers and public water supply systems may generate the large amounts of recharges. All of these urban facilities also may change the groundwater quality by the recharge of a myriad of contaminants. This study was performed to determine the factors controlling the recharge of deep groundwater in an urban area, based on the hydrogeochemical characteristics. The term ‘contamination’ in this study means any kind of inflow of shallow groundwater regardless of clean or contaminated. For this study, urban groundwater samples were collected from a total of 310 preexisting wells with the depth over 100 m. Random sampling method was used to select the wells for this study. Major cations together with Si, Al, Fe, Pb, Hg and Mn were analyzed by ICP-AES, and Cl, N $O_3$, N $H_4$, F, Br, S $O_4$and P $O_4$ were analyzed by IC. There are two groups of groundwater, based on hydrochemical characteristics. The first group is distributed broadly from Ca-HC $O_3$ type to Ca-C1+N $O_3$ type; the other group is the Na+K-HC $O_3$ type. The latter group is considered to represent the baseline quality of deep groundwater in the study area. Using the major ions data for the Na+K-HC $O_3$ type water, we evaluated the extent of groundwater contamination, assuming that if subtract the baseline composition from acquired data for a specific water, the remaining concentrations may indicate the degree of contamination. The remainder of each solute for each sample was simply averaged. The results showed that both Ca and HC $O_3$ represent the typical solutes which are quite enriched in urban groundwater. In particular, the P$CO_2$ values calculated using PHREEQC (version 2.8) showed a correlation with the concentrations of maior inorganic components (Na, Mg, Ca, N $O_3$, S $O_4$, etc.). The p$CO_2$ values for the first group waters widely ranged between about 10$^{-3.0}$ atm to 10$^{-1.0}$ atm and differed from those of the background water samples belonging to the Na+K-HC $O_3$ type (<10$^{-3.5}$ atm). Considering that the p$CO_2$ of soil water (near 10$^{-1.5}$ atm), this indicates that inflow of shallow water is very significant in deep groundwaters in the study area. Furthermore, the P$CO_2$ values can be used as an effective parameter to estimate the relative recharge of shallow water and thus the contamination susceptibility. The results of our present study suggest that down to considerable depth, urban groundwater in crystalline aquifer may be considerably affected by the recharge of shallow water (and pollutants) from an adjacent area. We also suggest that for such evaluation, careful examination of systematically collected hydrochemical data is requisite as an effective tool, in addition to hydrologic and hydrogeologic interpretation.ion.ion.

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2차원 바코드를 이용한 오디오 워터마킹 알고리즘 (A digital Audio Watermarking Algorithm using 2D Barcode)

  • 배경율
    • 지능정보연구
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    • 제17권2호
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    • pp.97-107
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    • 2011
  • 본 논문에서는 2차원 바코드를 이용한 오디오 워터마킹 알고리즘을 제안하였다. 삽입되는 워터마크 정보로는 2차원 바코드인 QR 코드를 변형하여 이용하였다. 2차원 바코드가 1차원 바코드에 비하여 많은 정보를 표현할 수 있고, 코드자체가 에러 보정능력을 내재하고 있는 장점을 이용하여 워터마킹 알고리즘의 견고성을 높였다. 또한 부분적인 워터마크 정보의 손실에 대응하기 위하여 직교코드를 이용하여 삽입대역을 확산했으며, 삽입강도 0.7에서 50dB 이상의 우수한 품질을 확보할 수 있었다.

R.C. 휨부재(部材)의 L.R.F.D. 신뢰성(信賴性) 설계기준(設計基準)에 관한 연구(研究) (A Study on LRFD Reliability Based Design Criteria of RC Flexural Members)

  • 조효남
    • 대한토목학회논문집
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    • 제1권1호
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    • pp.21-32
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    • 1981
  • 최근 구미(歐美) 선진제국(先進諸國)에서는 확률적(確率的)인 개념(槪念)에 의한 한계상태설계법(限界狀態設計法)을 표준시방서(標準示方書)로 도입(導入)하는 경향이 높아지고 있다. 이들 선진국(先進國)에서 채택한 LSD, LRFD, PBLSD 같은 신뢰성설계기준(信賴性設計基準)은 각종(各種) 시공재료(施工材料)에 대한 설계절차(設計節次)를 단순화(單純化)시킬 뿐만아니라 일관성(一貫性)있는 신뢰성(信賴性)을 갖게 하는 능력(能力)을 갖고 있다. 본(本) 연구(硏究)에서는 RC 휨부재(部材)에 대한 이러한 신뢰성설계기준(信賴性設計基準)을 제안(提案)하였다. 이를 위하여 Lind-Hasofer의 불변(不變)2차(次)모멘트 신뢰성이론(信賴性理論)에 의해 반복시행적(反復試行的) 신뢰성해석(信賴性解析) 및 하중(荷重)-저항계수(抵抗係數) 결정(決定)알고리즘을 유도하고, 또한 Cornell의 평균제(平均第)1계이차(階二次)모멘트법(法)을 사용하여 근사적(近似的)으로도 신뢰성(信賴性)을 해석(解析)하여 설계기준(設計基準)을 결정(決定)하도록 하였다. 휨부재(部材)의 저항(抵抗) 및 하중효과(荷重效果)에 대한 불확실양산정(不確實量算定)은 Ellingwood의 하중(荷重) 및 저항불확실량(抵抗不確實量) 해석방법(解析方法)을 따랐다. 현행(現行) 극한강설계시방서(極限强設計示方書) 기준(基準)으로 설계(設計)되는 R.C.휨부재(部材)의 상대적(相對的) 의미(意味)의 안전성수준(安全性水準)을 제안(提案)된 이차(二次)모멘트신뢰성이론(信賴性理論)에 의해 검토(檢討)하였다. 그리고 우리 현실(現實)을 고려한 ${\beta}_0=4$를 적절한 목표신뢰성지수(目標信賴性指數)로 간주(看做)하고 이에 대한 저항(抵抗) 및 하중계수(荷重係數)를 제안(提案)된 방법(方法)으로 계산(計算)하였으며, 현행(現行) 극한강설계기준(極限强設計基準)의 안전율(安全率)과 이들 계산(計算)된 계수(係數)를 비교(比較), 분석(分析)하였다. 현행(現行) 시방서(示方書)로 설계(設計)되는 휨부재(部材)의 신뢰성(信賴性) 수준(水準)은 적절(適切)하지 못하며, 현행(現行) 시방서(示方書)에 규정(規定)된 저항(抵抗) 및 하중계수(荷重係數)는 본연구(本硏究)의 신뢰성이론(信賴性理論)으로 유도한 저항(抵抗) 및 하중계수(荷重係數)와 상당히 차이(差異)가 있음을 발견(發見)할 수 있었다.

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다분류 SVM을 이용한 DEA기반 벤처기업 효율성등급 예측모형 (The Prediction of DEA based Efficiency Rating for Venture Business Using Multi-class SVM)

  • 박지영;홍태호
    • Asia pacific journal of information systems
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    • 제19권2호
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    • pp.139-155
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    • 2009
  • For the last few decades, many studies have tried to explore and unveil venture companies' success factors and unique features in order to identify the sources of such companies' competitive advantages over their rivals. Such venture companies have shown tendency to give high returns for investors generally making the best use of information technology. For this reason, many venture companies are keen on attracting avid investors' attention. Investors generally make their investment decisions by carefully examining the evaluation criteria of the alternatives. To them, credit rating information provided by international rating agencies, such as Standard and Poor's, Moody's and Fitch is crucial source as to such pivotal concerns as companies stability, growth, and risk status. But these types of information are generated only for the companies issuing corporate bonds, not venture companies. Therefore, this study proposes a method for evaluating venture businesses by presenting our recent empirical results using financial data of Korean venture companies listed on KOSDAQ in Korea exchange. In addition, this paper used multi-class SVM for the prediction of DEA-based efficiency rating for venture businesses, which was derived from our proposed method. Our approach sheds light on ways to locate efficient companies generating high level of profits. Above all, in determining effective ways to evaluate a venture firm's efficiency, it is important to understand the major contributing factors of such efficiency. Therefore, this paper is constructed on the basis of following two ideas to classify which companies are more efficient venture companies: i) making DEA based multi-class rating for sample companies and ii) developing multi-class SVM-based efficiency prediction model for classifying all companies. First, the Data Envelopment Analysis(DEA) is a non-parametric multiple input-output efficiency technique that measures the relative efficiency of decision making units(DMUs) using a linear programming based model. It is non-parametric because it requires no assumption on the shape or parameters of the underlying production function. DEA has been already widely applied for evaluating the relative efficiency of DMUs. Recently, a number of DEA based studies have evaluated the efficiency of various types of companies, such as internet companies and venture companies. It has been also applied to corporate credit ratings. In this study we utilized DEA for sorting venture companies by efficiency based ratings. The Support Vector Machine(SVM), on the other hand, is a popular technique for solving data classification problems. In this paper, we employed SVM to classify the efficiency ratings in IT venture companies according to the results of DEA. The SVM method was first developed by Vapnik (1995). As one of many machine learning techniques, SVM is based on a statistical theory. Thus far, the method has shown good performances especially in generalizing capacity in classification tasks, resulting in numerous applications in many areas of business, SVM is basically the algorithm that finds the maximum margin hyperplane, which is the maximum separation between classes. According to this method, support vectors are the closest to the maximum margin hyperplane. If it is impossible to classify, we can use the kernel function. In the case of nonlinear class boundaries, we can transform the inputs into a high-dimensional feature space, This is the original input space and is mapped into a high-dimensional dot-product space. Many studies applied SVM to the prediction of bankruptcy, the forecast a financial time series, and the problem of estimating credit rating, In this study we employed SVM for developing data mining-based efficiency prediction model. We used the Gaussian radial function as a kernel function of SVM. In multi-class SVM, we adopted one-against-one approach between binary classification method and two all-together methods, proposed by Weston and Watkins(1999) and Crammer and Singer(2000), respectively. In this research, we used corporate information of 154 companies listed on KOSDAQ market in Korea exchange. We obtained companies' financial information of 2005 from the KIS(Korea Information Service, Inc.). Using this data, we made multi-class rating with DEA efficiency and built multi-class prediction model based data mining. Among three manners of multi-classification, the hit ratio of the Weston and Watkins method is the best in the test data set. In multi classification problems as efficiency ratings of venture business, it is very useful for investors to know the class with errors, one class difference, when it is difficult to find out the accurate class in the actual market. So we presented accuracy results within 1-class errors, and the Weston and Watkins method showed 85.7% accuracy in our test samples. We conclude that the DEA based multi-class approach in venture business generates more information than the binary classification problem, notwithstanding its efficiency level. We believe this model can help investors in decision making as it provides a reliably tool to evaluate venture companies in the financial domain. For the future research, we perceive the need to enhance such areas as the variable selection process, the parameter selection of kernel function, the generalization, and the sample size of multi-class.

신장 핵의학 영상의 정량적 분석을 위한 관심영역 자동설정 기능 개발 및 사용자별 분석결과의 변화도 감소효과 분석 (Development of Automated Region of Interest for the Evaluation of Renal Scintigraphy : Study on the Inter-operator Variability)

  • 이형구;송주영;서태석;최보영;신경섭
    • 한국의학물리학회지:의학물리
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    • 제12권1호
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    • pp.41-50
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    • 2001
  • 신장 핵의학 영상의 정량적 분석시 설정하게 되는 관심영역은 그 설정 위치 및 모양과 크기에 따라 서로 다른 분석 결과를 도출하게 한다. 따라서, 관심영역을 사용자가 직접 육안으로 판별하여 수동으로 설정하는 경우, 사용자별 주관적 요소에 의해 위치 및 형태가 서로 상이한 관심영역을 설정하게 되어 동일한 자료를 분석하더라도 그 결과가 모두 상이한 값을 갖게 되는 문제점이 발생한다. 본 연구에서는 관심영역 수동설정시 사용자별 관심영역 설정의 변화도가 실제 신장기능 분석결과에 어느 정도의 영향을 주는지를 조사하였으며, 수동설정시보다 일관성 있는 결과를 얻기 위해 여러방법의 자동설정 기능을 개발하여 그 적용 결과를 분석하였다. 관심영역의 설정에 따른 결과분석을 위한 지표값으로 좌ㆍ우 신장의 상대적 섭취도, 사구체여과율 및 평균통과시간을 선정하였고, IDL5.2로 프로그래밍하여 분석용 도구로서 적합한 소프트웨어를 개발하였으며, $^{99m}$ Tc-DTPA를 주입하여 얻은 총 11명의 정상인 신장 핵의학 영상을 대상으로 9명의 사용자들이 수행한 신장기능 평가 결과를 분석하였다. 신장 관심영역의 자동설정을 위해 영상내 화소들의 gradient값을 이용한 역치(threshold)의 계산과 border tracing기법을 적용하였으며, 배후 관심영역과 대동맥의 관심영역은 좌ㆍ우 신장의 관심영역이 설정 완료된 후, 영상내 기하학적 정보와 화소값을 참조로 하여 자동으로 설정되도록 하였다. 신장 관심영역의 자동설정 기능으로 사용자 주관적 요소의 배제 정도에 따라 4가지 방법을 개발하였으며, 각각의 적용결과를 비교, 분석하였다. 이 4가지 관심영역 자동설정 기능들은 그 구현 방법에 따라 조금씩의 차이는 있었지만, 수동설정시보다 정량적 분석 결과값의 사용자별 편차를 확연히 감소시켜, 신장 핵의학 영상의 정량적 분석시 객관적 기준을 통한 일관성 있는 결과를 도출함에 있어 그 기능의 상대적 우수성을 입증하였다.

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국경을 넘는 해양환경오염에 대한 국가책임과 적용의 한계 -중국의 산샤댐 건설로 인한 동중국해 해양환경 영향을 중심으로- (Limitations of National Responsibility and its Application on Marine Environmental Pollution beyond Borders -Focused on the Effects of China's Three Gorges Dam on the Marine Environment in the East China Sea-)

  • 양희철
    • Ocean and Polar Research
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    • 제37권4호
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    • pp.341-356
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    • 2015
  • A nation has a sovereign right to develop and use its natural resources according to its policies with regard to development and the relevant environment. A nation also has an obligation not to harm other countries or damage environments of neighboring countries as consequences of such actions of developments or use of natural resources. However, international precedents induce a nation to take additional actions not to cause more damages from the specific acts causing environmental damages beyond national borders, when such acts have economic and social importance. That is to say that there is a tendency to resolve such issues in a way to promote the balance between the mutual interests by allowing such actions to continue. A solution to China's Three Gorges Dam dilemma based on a soft law approach is more credible than relying on a good faith approach of national responsibilities and international legal proceedings since the construction and operation of the dam falls within the category of exercising national sovereign rights. If a large scale construction project such as the Three Gorges Dam or operation of a nuclear power plant causes or may cause environmental damage beyond the border of a nation engaged in such an undertaking, countries affected by this undertaking should jointly monitor the environmental effects in a spirit of cooperation rather than trying to stop the construction and should seek cooperative solutions of mutual understanding to establish measures to prevent further damages. If China's Three Gorges Dam construction and operation cause or contain the possibility of causing serious damages to marine environment, China cannot set aside its national responsibility to meet international obligations if China is aware of or knows about the damage that has occurred or may occur but fail to prevent, minimize, reverse or eliminate additional chances of such damages, or fails to put in place measures in order to prevent the recurrence of such damages. However, Korea must be able to prove a causal relationship between the relevant actions and resulting damages if it is to raise objections to the construction or request certain damage-prevention actions against crucial adverse effects on the marine environment out of respect for China's right to develop resources and acts of use thereof. Therefore, it is essential to cumulate continuous monitoring and evaluations information pertaining to marine environmental changes and impacts or responses of affected waters as well as acquisition of scientific baseline data with observed changes in such baseline. As China has adopted a somewhat nonchalant attitude toward taking adequate actions to protect against marine pollution risks or adverse effects caused by the construction and operation of China's Three Gorges Dam, there is a need to persuade China to adopt a more active stance and become involved in the monitoring and co-investigation of the Yellow Sea in order to protect the marine environment. Moreover, there is a need to build a regular environmental monitoring system that includes the evaluation of environmental effects beyond borders. The Espoo Convention can serve as a mechanism to ease potential conflicts of national interest in the Northeast Asian waters where political and historical sensitivities are acute. Especially, the recent diplomatic policy advanced by Korea and China can be implemented as an important example of gentle cooperation as the policy tool of choice is based on regional cooperation or cooperation between different regions.

성인 요로 감염 환자에서 $^{99m}Tc-DMSA$ 삼중검출기 SPECT 영상의 유용성 (Triple Detector SPECT Imaging with $^{99m}Tc-DMSA$ in Adult Patients with Urinary Tract Infection)

  • 류진숙;배원규;문대혁;이명혜;김순배;박수길;박정식;홍창기;조경식
    • 대한핵의학회지
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    • 제26권2호
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    • pp.290-298
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    • 1992
  • Although early diagnosis of urinary tract infection is important, the radiologic evaluation is still controversial because of the low sensitivity and the lack of cost-effectiveness. This study was carried out to evaluate the clinical utility of high resolution triple head $^{99m}Tc-DMSA$ SPECT imaging in urinary tract infection. We prospectively performed $^{99m}Tc-DMSA$ planar and SPECT imaging, ultrasound of kidney (US), intravenous pyelography (IVP) and voiding cystourethrography (VCU) in all 60 adult patients with UTI [26 with first episode of acute pyelonephritis (APN), 22 with recurrent APN, and 12 persistent asymptomatic pyuria] and 25 normal persons. To assess reversibility of the renal cortical defect (RCD), $^{99m}Tc-DMSA$ SPECT was repeated 1 to 8 months later in those patients with abnormal initial findings. Overall detection rate of $^{99m}Tc-DMSA$ SPECT imaging was 83% (50/60), but planar, US, IVP and VCU showed abnormal findings in 68%, 28%, 32% and 13%, respectively. 25 out of 27 patients with normal or single RCD were all normal in other radioligic studies. Only two patients showed vesicoureteral reflux (VUR) on VCU (grade I) and mild hydronephrosis on IVP. But, high proportion of those with multiple RCD showed abnormal findings on US (17/33), IVP (18/33), and VCU (7/33): 67% in any of these 3 studies. Especially, 3 out 7 patients with VUR showed multiple RCD on $^{99m}Tc-DMSA$ SPECT without any abnormality on IVP or US. 25 normal persons showed normal findings in all studies except one false positive finding on $^{99m}Tc-DMSA$ SPECT imaging. Follow-up $^{99m}Tc-DMSA$ SPECT was done in 28 patients (13 with single RCD, 15 with multiple RCD). All 13 patients with single RCD showed improvement. Those with multiple RCD presented improvement in 4, no change in 10, and aggravation in 1 on follow-up studies. With these results, we conclude: 1) $^{99m}Tc-DMSA$ SPECT imaging is superior to planar imaging, US, IVP or VCU in detection of renal lesion in urinary tract infection. $^{99m}Tc-DMSA$ SPECT is useful as a initial diagnostic tool in adult patients with urinary tract infection. 2) The multiple RCD on $^{99m}Tc-DMSA$ SPECT represent the high probability of irreversible tissue change and need of extensive urological work-up.

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