터어키안 및 그 주위 종양에서 이중시기 나선식CT를 이용한 조영 증강 양상의 분석

우지영,유재욱,나동규,노홍기,변홍식,Woo, Ji-Young,Ryoo, Jae-Wook,Na, Dong-Gyu,Roh, Hong-Gee,Byun, Hong-Sik 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1

목적: 이중시기 나선식 CT에서 나타나는 터어키안 및 그 주위 종양의 조영 증강 양상을 알아보고자 하였다. 대상과 방법: 수술로 진단된32명의 터어키안 및 그 주위 종양을 가진 환자를 대상으로 하였다. 수막종이 17예, 뇌하수체 거대선종 6예, 신경성 종양 5예, 해면 혈관종, 연골육종, 골육종, 접형동 종양이 각 1예였다. 이중시기 나선식 CT는 초당 3 ml로 90 ml의 조영제를 주입한 후 30초와 120초 후에 조기 및 지연 횡단 영상을 얻었고,횡단면 영상을 얻은 후 관상면 영상을 얻었다. 종양의 감쇠 변화와 조영 증강 양상을 육안적으로 평가하였고,조기 횡단 영상에 대한 지연 횡단 및 지연 관상면 영상의 CT수치의 비율을 정량적으로 분석하였다. 결과: 육안적 평가에서 조기 횡단 영상에 대한 지연 횡단 영상의 감쇠 변화는 수막종17예 모두(100%)에서 감소하였고, 뇌하수체 거대선종6예 모두(100%)에서는 뚜렷한 차이를 보이지 않았으며, 신경성 종양 5예 모두(100%)에서 증가하였다.조기 횡단 영상에 대한 지연 관상면 영상의 감쇠 변화는 수막종 17예 모두(100%)에서 감소하였고, 신경성 종양 5예 모두(100%)에서 증가하였으며, 뇌하수체 거대선종 6예중 4예(66.7%)에서는 뚜렷한 차이를 보이지 않았다. 수막종, 신경성 종양, 뇌하수체 거대선종에서 계산한 CT 수치의 비율은 통계적으로 유의한 차이를 보였다 (p<0.05). 결론: 이중시기 나선식 CT에서 터어키안 과 그 주위 종양은 병리에 따라 특징적인 조영 증강양상을 나타냈다. 이중시기 나선식 CT를 이용한 조영 증강 양상의 분석은 이들 종양의 감별진단에 도움이 될 것으로 생각된다. Purpose: To assess the enhancement patterns of sellar and parasellar tumors at two-phase helical CT. Materials and Methods: Thirty-two patients with pathologically proven sellar and parasellar tumors [meningioma (n=17), pituitary mocroadenoma (n=6), neurogenic tumor (n=5), cavernous angioma (n=1), chondrosarcoma (n=1), osteosarcoma (n=1), sphenoid carcinoma (n=1)] were included in this study. Two-phase helical CT was performed after the injection of 90 mL of contrast material at a rate of 3 mL/sec. Transverse helical CT scans were obtained during the early and late phases, with scanning delays of 30 and 120 seconds, respectively. Delayed coronal images were obtained after delayed axial images. Attenuation change and the enhancement patterns of the tumors were visually assessed; the former was also assessed quantitatively as the ratio of the CT number at late-phase axial and coronal scanning to that at early-phase scanning. Results: Visual assessment of two-phase helical CT images revealed decreased attenuation in all 17 meningiomas, no change in all six pituitary macroadenomas and increased attenuation in 5 all five neurogenic tumors on late-phase axial scans as compared with early phase scans. Coronal images showed decreased attenuation in all 17 meningiomas, increased attenuation in all five neurogenic tumors and no change in four pituitary macroadenomas (66.7%). The ratio of CT numbers was significantly different between meningiomas, neurogenic tumors and pituitary macroadenomas(p<0.05). Conclusion: According to their histopathology, sellar and parasellar tumors showed characteristic enhancement patterns at two-phase helical CT. An analysis of the observed enhancement patterns can be useful in the differential diagnosis of juxtasellar tumors.

뇌에서 발생한 원발성 섬유조직구종 -증례보고-

김동천 ( Dong Cheon Kim ),조준 ( Joon Cho ),조요한 ( Yo Han Cho ),노홍기 ( Hong Gee Roh ),임소덕 ( So Dug Lim ),고영초 ( Young Cho Koh ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Malignant fibrous histiocytoma(MFH) is a soft tissue sarcoma arising from the extremities and retroperitoneum in older adults. Primary intracranial MFH is extremely rare. A 29-year-old woman presented with headache showing three large masses on brain magnetic resonance image(MRI). She had undergone extended total gastrectomy with splenectomy under the diagnosis of advanced gastric cancer three years previously. Systemic positron extension tomography(PET) computed tomography(CT) scan on routine follow-up study before the first brain surgery revealed no hot spots. Three masses were totally removed at a single session. The pathology was confirmed to be typical MFH. Two months after the first brain surgery, she underwent tonsillectomy due to a rapidly growing tonsillar mass and the pathology was found out to be MFH. Postoperative neck CT with angiography for the evaluation of hypotension showed no significant finding. Except for the tonsillar mass, she had been symptom free during 10 months after the first brain surgery. Between 11th and 18th months postoperatively, multiple intracranial recurrences including metastatic lesions of the mediastinum and the spine were noticed. She died of pneumonia 20 months after the first brain surgery during salvage chemotherapy. We report a rare case of primary MFH of the brain with a past medical history of advanced gastric cancer.

임상 : 역형성 핍지교종 환자의 치료 결과에 관한 연구

이성호 ( Sung Ho Lee ),고영초 ( Young Cho Koh ),최우진 ( Jin Woo Choe ),조요한 ( Yo Han Cho ),노홍기 ( Hong Gee Roh ),홍세미 ( Se Mi Hong ),임소덕 ( So Duck Lim ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objects:To evaluate prognostic impacts of surgical extent, postoperative Karnofsky performance status(KPS), and chemotherapy( CTx) in patients with anaplastic oligodendroglioma(AO), the authors analyzed the overall survival(OS) and progression free survival(PFS) in these patients according to those factors. Methods:Twenty nine patients with AO, who had undergone surgery by a single surgeon at the three university hospitals where the senior author had been active staff during the last 20 years, were enrolled in this retrospective analysis. Maximal safe resection was tried in all cases with or without neuronavigation techniue. The extent of removal was evaluated by immediate postoperative MRI. Impact of surgical extent, CTx, and postoperative KPS were evaluated on the OS and PFS in these patients. Results:Thirteen men and 16 women patients with the mean age at the diagnosis of 42.9 years(7-71 yrs) were included in this study. The mean follow-up duration was 61.8 months(3-237 months) and 12 patients died of tumor progression during the follow-up. There was no operative mortality. Gross total resection(GTR) was done in 15 patients, and either subtotal resection(STR) or partial resection(PR) was done in 14 patients. Of the 29 patients 26 were subjected to conventional radiotherapy(RT). The three remaining patients in poor KPS, less than 60, didn`t undergo RT. Twenty patients were subjected to CTx either with PCV(procarbazine, CCNU, vincristine) or Temozolomide(TMZ). Nineteen patients tolerated well the CTx with mild to moderate hematological or other toxicities and could finish the 6 or 7 cycles of PCV or TMZ. During the follow-up, tumor recurrences had been observed in 13 patients, for whom additional operations and /or salvage CTx were tried. GTR affects significantly on OS and PFS(p<0.01). Good postoperative KPS was also favorable for OS and PFS(p<0.05). Adjuvant CTx either with PCV or TMZ in addition to RT in patients with AO was not statistically significant prognostic impact for OS and PFS in this study(p>0.05). Conclusion:From this single-surgeon-operated series, the authors could confirm significant prognostic impacts of radical surgery, and good postoperative KPS in patients with AO on PFS and OS.

Development of a software application for the segmentation of a cerebral infarction from 3D diffusion weighted imaging

Hoang Long Le,Trinh Thi Le Vuong,Chang Hee Han(한창희),Tan Nhu Nhat Doan,Hong Gee Roh(노홍기),Hyun Jeong Kim(김현정),Jin Tae Kwak(곽진태) 한국정보과학회 2021 한국정보과학회 학술발표논문집 Vol.2021 No.6

편측 시력 손실을 초래한 거대 안상 유피낭종의 수술적 치료

이성호(Sung-Ho Lee),고영초(Young-Cho Koh),조준(Joon Cho),오지영(Jee-Young Oh),노홍기(Hong Gee Roh),임소덕(So-Dug Lim) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

Suprasellar epidermoid tumor presenting with visual loss is rare. A 50-year-old woman was referred for treatment of a large well demarcated cystic mass at the suprasellar region. She had a history of left visual loss for several years. To preserve the vision of right side, we underwent VEP (visual evoked potential) preoperatively and monitored VEP during the surgery. During surgery, the right optic nerve was severely compressed by the tumor, and was successfully decompressed without damage to the optic nerve. The left optic nerve was more severely compressed by the fibrotic and calcified tumor capsule around the optic canal. The 6 cm sized multilobulated tumor was subtotally resected while preserving the visual functions of the right side. We report a case of giant epidermoid tumor with unilateral visual loss, for which surgical removal was aided by VEP monitoring to save the only remaining vision.