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B형간염바이러스에 의한 만성간질환환자에서 간세포암발견을 위한 선별초음파검사의 유용성: 만성간염환자와 간경변증환자의 비교
장삼열,최동일,임재훈,박윤옥,임효근,이원재,김승훈,장경미,최문석,백승운 대한영상의학회 2004 대한영상의학회지 Vol.51 No.3
Purpose: To evaluate the usefulness of screening liver ultrasonography (US) for hepatocellular carcinoma (HCC) detection in patients with chronic hepatitis or hepatic cirrhosis caused by hepatitis B virus (HBV). Materials and Methods: A retrospective study was performed with 1,189 patients with clinical hepatopathy caused by HBV who underwent screening liver US for HCC detection at least twice. All patients were followed up with liver US examinations (mean, 8.3 times), CT, or MR for at least 3 months (range, 3-102 months; mean, 47 months) for the detection of HCC. The study population was divided into two groups: chronic hepatitis (n=492) and hepatic cirrhosis (n=697), which was further divided into two groups with (n=156) or without (n=541) evident shrinkage. The radiologic examinations that had detected HCC for the first time were analyzed and compared between the groups. Results: Among 20 (4.1%) patients with chronic hepatitis and 132 (18.9%) patients with hepatic cirrhosis diagnosed as HCC, screening US was the modality of detection in 17 (85.0%) of 20 patients with chronic hepatitis and 76 (57.6%) of 132 patients with hepatic cirrhosis (p=0.038, Chi-square test). The detection rate of HCC on screening US between the chronic hepatitis and hepatic cirrhosis with evident shrinkage (51.4%, 19/37) showed a significant difference (p=0.027, Chi-square test). Conclusion: For chronic liver disease caused by HBV, screening US for HCC detection is more useful in patients with chronic hepatitis than with hepatic cirrhosis with evident shrinkage. 목적: B형간염바이러스에 의한 만성간염과 간경변증 환자에서 간세포암발견을 위해 시행하는 선별간초음파검사의 유용성을 평가하고자 하였다. 대상과 방법: 1999년 3월부터 2000년 2월까지 1년 동안 외래 혹은 입원 환자들 중 B형간염바이러스에 의한 만성간염 혹은 간경변증 진단을 받은 환자들을 대상으로 하였으며, 이들 중 간세포암 발견을 위해 적어도 2회 이상 선별간초음파검사를 받은 1,189명의 환자들을 최종 대상으로 후향연구를 시행하였다. 모든 환자들을 적어도 3개월이상(범위, 3-102개월; 평균, 47개월) 간초음파검사, CT, MR 등으로 간세포암을 발견하기 위해 추적하였다(초음파추적검사횟수, 평균 8.3회). 연구집단은 만성간염(492예)과 간경변증(697예)의 두 집단으로 나누었으며, 다시 간경변증을 뚜렷한 위축을 동반한 집단(156예)과 동반하지 않은 집단(541예)으로 나누어 간세포암을 처음 발견한 방사선학적검사들을 분석하고 비교하였다. 결과: 추적기간 동안 간세포암으로 진단받은 만성간염환자 20명(4.1%)과 간경변증환자 132명(18.9%) 중, CT나 MR이 아닌 선별초음파검사에서 간세포암이 처음 발견된 환자는 만성간염환자 중 17명(85.0%)과 간경변증환자 중 76명(57.6%)으로, 만성간염환자군에서의 분율이 의미있게 높았으며(p=0.038, Chi-square test), 특히 뚜렷한 위축을 동반한 간경변증환자군에서의 초음파발견률(51.4%,19/37)과 유의한 차이를 보였다(p=0.027, Chi-square test). 결론: B형간염바이러스에 의한 간질환환자에서 간세포암발견을 위해 시행하는 선별간초음파검사는 뚜렷한 위축을 동반한 간경변증환자보다 만성간염환자에서 더욱 유용하였다.
Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review
장삼열,Mok Sujung,Park Sung Cheol,Kim Hyoungmin,장봉순 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4
Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.