• 대한안과학회지
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• 제59권11호
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• pp.1097-1102
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• 2018

목적: 클로르페나피르 음독 후 중추신경계 손상을 동반한 독성 시신경병증 1예를 보고하고자 한다. 증례요약: 44세 여자가 7일 전부터의 양안 시력저하를 주소로 내원하였다. 환자는 내원 2주 전 자살 목적으로 클로르페나피르 한 모금을 음독했고, 직후 근처 병원에서 위세척을 시행하였다. 초기 최대교정시력은 우안 안전수지 30 cm, 좌안 안전수동이었다. 양안 동공은 5.0 mm로 커져 있었고, 빛에 대한 반응은 느렸으며 좌안에는 상대구심동공운동장애가 관찰되었다. 안저검사에서 양안 시신경유두부종이 관찰되었고, 뇌자기공명영상에서 양안 시신경과 속섬유막, 뇌량, 중소뇌각, 뇌간 등 백질 신경로를 따라 양쪽에 대칭적인 고강도신호가 관찰되었다. 클로르페나피르 중독으로 인한 독성 시신경병증으로 진단 후, 고용량 스테로이드치료를 3일간 시행하였으나 양안 최대교정시력은 광각무로 악화되었다. 3개월 후, 안저검사에서 양안 시신경위축이 관찰되었고, 빛간섭단층촬영에서 망막신경섬유층 및 신경절세포-내망상세포층 두께가 감소하였다. 결론: 매우 적은 양이라도 클로르페나피르에 노출되면 적절한 치료에도 불구하고 잠복기를 거쳐 심각한 시신경손상이 발생할 수 있으므로 주의해야 하겠다.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.78-87
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• 2021

Objective : Intraoperative neurophysiological monitoring (IONM) has been widely used during spine surgery to reduce or prevent neurologic deficits, however, its application to the surgical management for cervical myelopathy remains controversial. This study aimed to assess the success rate of IONM in patients with cervical myelopathy and to investigate the factors associated with successful baseline monitoring and the effect of increasing the stimulation intensity by focusing on motor evoked potentials (MEPs). Methods : The data of 88 patients who underwent surgery for cervical myelopathy with IONM between January 2016 and June 2018 were retrospectively reviewed. The success rate of baseline MEP monitoring at the initial stimulation of 400 V was investigated. In unmonitorable cases, the stimulation intensity was increased to 999 V, and the success rate final MEP monitoring was reinvestigated. In addition, factors related to the success rate of baseline MEP monitoring were investigated using independent t-test, Wilcoxon rank-sum test, chi-squared test, and Fisher's exact probability test for statistical analysis. The factors included age, sex, body mass index, diabetes mellitus, smoking history, symptom duration, Torg-Pavlov ratio, space available for the cord (SAC), cord compression ratio (CCR), intramedullary increased signal intensity (SI) on magnetic resonance imaging, SI length, SI ratio, the Medical Research Council (MRC) grade, the preoperative modified Nurick grade and Japanese Orthopedic Association (JOA) score. Results : The overall success rate for reliable MEP response was 52.3% after increasing the stimulation intensity. No complications were observed to be associated with increased intensity. The factors related to the success rate of final MEP monitoring were found to be SAC (p<0.001), CCR (p<0.001), MRC grade (p<0.001), preoperative modified Nurick grade (p<0.001), and JOA score (p<0.001). The cut-off score for successful MEP monitoring was 5.67 mm for SAC, 47.33% for the CCR, 3 points for MRC grade, 2 points for the modified Nurick grade, and 12 points for the JOA score. Conclusion : Increasing the stimulation intensity could significantly improve the success rate of baseline MEP monitoring for unmonitorable cases at the initial stimulation in cervical myelopathy. In particular, the SAC, CCR, MRC grade, preoperative Nurick grade and JOA score may be considered as the more important related factors associated with the success rate of MEP monitoring. Therefore, the degree of preoperative neurological functional deficits and the presence of spinal cord compression on imaging could be used as new detailed criteria for the application of IONM in patients with cervical myelopathy.

• 분석과학
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• 제35권5호
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• pp.205-211
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• 2022

Deuterium (D) is an isotope with one more neutron number than hydrogen (H). Heavy elements rarely change their chemical properties with little effect even if the number of neutrons increases, but low-mass elements change their vibration energy, diffusion rate, and reaction rate because the effect cannot be ignored, which is called an isotope effect. Recently, in the semiconductor and display industries, there is a trend to replace hydrogen gas (H₂) with deuterium gas (D₂) in order to improve process stability and product quality by using the isotope effect. In addition, as the demand for D₂ in industries increases, domestic gas producers are making efforts to produce and supply D₂ on their own. In the case of high purity D₂, most of them are produced by electrolysis of heavy water (D₂O), and among D₂, hydrogen deuteride (HD) molecules are present as isotope impurities. Therefore, in order to maximize the isotope effect of hydrogen in the electronic industry, HD, which is an isotope impurity of D₂ used in the process, should be small amount. To this end, purity analysis of D₂ for industrial processing is essential. In this study, HD quantitative analysis of D₂ for high purity D₂ purity analysis was established and hydrogen isotope RM (Reference material) was developed. Since hydrogen isotopes are difficult to analyze with general gas analysis instrument, they were analyzed using a high-precision mass spectrometer (Gas/MS, Finnigan MAT271). High purity HD gas was injected into Gas/MS, sensitivity was determined by a signal according to pressure, and HD concentrations in two bottles of D₂ were quantified using the corresponding sensitivity. The amount fraction of HD in each D₂ was (4518 ± 275) μmol/mol, (2282 ± 144) μmol/mol. D₂, which quantifies HD amount using the developed quantitative analysis method, will be manufactured with hydrogen isotope RM and distributed for quality management and maintenance of electronic industries and gas producers in the future.

• Korean Journal of Radiology
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• 제22권9호
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• pp.1451-1461
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• 2021

Objective: Adequate methods of combining T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) to assess complete response (CR) to chemoradiotherapy (CRT) for rectal cancer are obscure. We aimed to determine an algorithm for combining T2WI and DWI to optimally suggest CR on MRI using visual assessment. Materials and Methods: We included 376 patients (male:female, 256:120; mean age ± standard deviation, 59.7 ± 11.1 years) who had undergone long-course CRT for rectal cancer and both pre- and post-CRT high-resolution rectal MRI during 2017-2018. Two experienced radiologists independently evaluated whether a tumor signal was absent, representing CR, on both post-CRT T2WI and DWI, and whether the pre-treatment DWI showed homogeneous hyperintensity throughout the lesion. Algorithms for combining T2WI and DWI were as follows: 'AND,' if both showed CR; 'OR,' if any one showed CR; and 'conditional OR,' if T2WI showed CR or DWI showed CR after the pre-treatment DWI showed homogeneous hyperintensity. Their efficacies for diagnosing pathologic CR (pCR) were determined in comparison with T2WI alone. Results: Sixty-nine patients (18.4%) had pCR. AND had a lower sensitivity without statistical significance (vs. 62.3% [43/69]; 59.4% [41/69], p = 0.500) and a significantly higher specificity (vs. 87.0% [267/307]; 90.2% [277/307], p = 0.002) than those of T2WI. Both OR and conditional OR combinations resulted in a large increase in sensitivity (vs. 62.3% [43/69]; 81.2% [56/69], p < 0.001; and 73.9% [51/69], p = 0.008, respectively) and a large decrease in specificity (vs. 87.0% [267/307]; 57.0% [175/307], p < 0.001; and 69.1% [212/307], p < 0.001, respectively) as compared with T2WI, ultimately creating additional false interpretations of CR more frequently than additional identification of patients with pCR. Conclusion: AND combination of T2WI and DWI is an appropriate strategy for suggesting CR using visual assessment of MRI after CRT for rectal cancer.

• Korean Journal of Radiology
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• 제22권5호
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• pp.725-734
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• 2021

Objective: To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). Materials and Methods: This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size (< 20 mm or ≥ 20 mm). Results: The frequency of portal venous phase (PP) washout with HBA-MRI was comparable to that of delayed phase (DP) washout with ECA-MRI (77.2% [88/114] vs. 68.4% [78/114]; p = 0.134). The frequencies were also comparable when IW was allowed (79.8% [91/114] for HBA-MRI vs. 81.6% [93/114] for ECA-MRI; p = 0.845). The sensitivities for HCC of LR-5 (using PP or DP washout) were comparable between HBA-MRI and ECA-MRI (78.1% [89/114] vs. 73.7% [84/114]; p = 0.458). In HCCs < 20 mm, the sensitivity of LR-5 was higher on HBA-MRI than on ECA-MRI (70.8% [34/48] vs. 50.0% [24/48]; p = 0.034). The sensitivity was similar to each other if IW was added to LR-5 (72.9% [35/48] for HBA-MRI vs. 70.8% [34/48] for ECA-MRI; p > 0.999). Conclusion: Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.

• 대한영상의학회지
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• 제83권3호
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• pp.620-631
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• 2022

목적 유방암 환자의 수술 전 자기공명영상에서 림프절 전이를 시사하는 소견들에 따른 진단 성적을 알아보고자 한다. 대상과 방법 수술 전 유방 자기공명영상을 촬영하고 유방암 수술을 시행한 192명의 환자를 후향적으로 분석하였다. 영상 소견에서 림프절의 크기와 장경/단경의 비율, 피질의 두께와 모양, 변연, 수질의 소실, 비대칭성, T2 강조영상에서의 신호강도, 이른 조영증강의 정도, 조영증강의 역학을 조사하였다. 수신자판단특성곡선 분석, 카이 분석과 t-검정, 맥니마 검정을 이용하여 통계분석을 시행하였다. 결과 단경의 증가, 피질의 불규칙한 모양과 피질 두께의 증가, 수질의 소실, 비대칭성, 피질의 불규칙한 변연 그리고 T2 강조영상에서의 낮은 신호강도는 전이를 시사하는 의미 있는 소견이었다. 이중 단경과 피질의 두께에 대해 수신자판단특성곡선 분석으로 각각 8.05 mm와 2.75 mm로 절단값을 얻었다. 2.75 mm 이상의 피질 두께, 피질의 불규칙한 모양은 맥니마 검정으로 다른 소견들과 비교할 때 민감도의 유의한 차이를 보였다. 피질의 불규칙한 변연(100%)은 가장 높은 특이도를 보였다. 결론 유방 자기공명영상의 전이 림프절 분석에서 2.75 mm 이상의 피질 두께와 피질의 불규칙한 모양은 다른 소견들보다 높은 민감도를 보이고 피질의 불규칙한 변연은 가장 높은 특이도를 보이는 소견이다.

• 대한영상의학회지
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• 제83권5호
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• pp.1160-1167
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• 2022

심장막 주위 지방 괴사는 급성흉통의 비교적 드문 원인으로서 현재까지 영문으로 보고된 소아 증례는 5건에 불과하다. 심장막 주위 지방 괴사는 급성 흉막통증의 임상증상과 종격동이나 심장막 부위에 타원형의 피막으로 둘러싸인 지방 병소로 나타나는 전형적인 전산화단층촬영 소견으로 진단할 수 있다. 성인의 경우 조영증강 자기공명영상 검사가 전형적인 지방신호 변화를 확인할 수 있어 유용하다는 보고가 있다. 본 논문에서는 저자들은 소아 심장막 주위 지방 괴사 환자의 증례를 통해 조영증강 자기공명영상 소견에 대해 기술하고 급성흉통의 감별진단에 있어 유용성을 보고한다.

• 대한영상의학회지
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• 제83권6호
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• pp.1385-1393
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• 2022

화생성 유방암은 상피성 암과 다양한 화생성 변화가 혼합된 형태의 암으로, 드물게 발생하나, 높은 재발률과 전이율을 보이는 공격적 성향을 가진 암이다. 연골성 분화를 보이는 화생성 암은 화생성 유방암의 아형 중에서도 상대적으로 드물게 발생하며, 다른 아형에 비해 비교적 좋은 예후를 보인다. 저자들은 연골성 분화를 보이는 화생성 유방암으로 진단된 3명의 환자의 영상의학적 소견을 다음과 같이 보고한다. 유방촬영상 무정형 또는 거친 불균질한 석회화를 동반한 고밀도 종괴를 보이고 초음파상 미세소엽형 또는 불분명한 경계를 가진 복합성 낭성 및 고형성 종괴(complex cystic and solid mass)로 보인다. 자기공명영상에서 비교적 경계가 분명한 또는 부분적으로 경계가 불분명한 종괴로, T2 강조영상에서 비균질한 고신 호강도를 보이고, 빠른 초기 조영증강 및 말기 세척형의 신호강도 감소를 동반한 비균질한 조영증강이나 가장자리 조영증강을 보인다.

• 대한영상의학회지
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• 제81권2호
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• pp.379-394
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• 2020

목적 유방암 환자의 MRI에서 발견된 추가적 병변의 악성 예측을 위한 점수체계를 설계하고자 하였다. 대상과 방법 68명 유방암 환자의 86개 MRI 발견 병변(64 양성, 22 악성)이 후향적으로 연구되었다. 스튜던트 t 검정, Fisher 정확검정, 로짓 회귀분석을 이용해 영상적 소견과 조직학적 결과의 상관관계를 분석했다. 의미 있는 악성 시사 소견을 기반으로 한 점수체계를 설계하고 그 것의 진단적 능력을 Breast Imaging-Reporting and Data System (이하 BI-RADS) category와 비교하였다. 결과 병변 크기 ≥ 8 mm (p < 0.001), 주 병소와 동일한 사분면에 위치(p = 0.005), 지연기의 고원형 조영 증강(p = 0.010), T2 등신호(p = 0.034) 혹은 저신호 강도(p = 0.024), 불규칙한 종괴 모양(p = 0.028)이 악성과 관련 있었다. 이 소견들과 의심스러운 비종괴 내부 조영 양상을 바탕으로 한 점수체계는 BI-RADS의 진단적 능력을 향상시켰고(area under the curve, 0.918 vs. 0.727), 3개의 위음성 케이스를 방지할 수 있었다. 또한, 22개의 불필요한 2차 초음파 검사(22/66, 33.3%)를 줄일 수 있었다. 결론 병변 크기, 주 병소와의 상대적 위치, 지연기의 조영 증강 양상, T2 신호강도, 종괴의 모양 및 비종괴 내부 조영 양상을 기반으로 한 점수체계는 유방암 환자의 MRI 발견 병소를 평가하는데 있어 정확도를 높여 줄 수 있다.

• Korean Journal of Radiology
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• 제23권4호
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• pp.389-401
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• 2022

Objective: This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination. Materials and Methods: We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0-2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0-3) or high-FLIS (4-6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed. Results: Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32-1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9-98.4) and a specificity of 89.0% (95% CI: 80.2-94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6-98.3) and a specificity of 83.8% (95% CI: 68.0-93.8). Conclusion: Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.