MR Imaging Findings of Mercury Deposits in the Upper Arm: A Case Report

주승문,최정아,홍성환,최자영,김여주,오주한,정진행,강흥식 대한영상의학회 2008 대한영상의학회지 Vol.59 No.2

The incidental injection of metallic mercury into soft tissue is a rare event in the general population. Mercury can produce local inflammation, abscesses, granuloma, and membranous fat necrosis. Herein, we report a rare case of soft tissue mercury deposits with imaging findings, including magnetic resonance (MR) imaging findings, located at the mercury droplet deposits which appear as signal voids on all sequences, with surrounding intermediate to high signal intensity on the T2- weighted image.

Optimized Performance of FlightPlan during Chemoembolization for Hepatocellular Carcinoma: Importance of the Proportion of Segmented Tumor Area

주승문,김용표,염태준,은나래,이다혜,이광훈 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.5

Objective: To evaluate retrospectively the clinical effectiveness of FlightPlan for Liver (FPFL), an automated tumor-feeding artery detection software in cone-beam CT angiography (CBCTA), in identifying tumor-feeding arteries for the treatment of hepatocellular carcinoma (HCC) using three different segmentation sensitivities. Materials and Methods: The study included 50 patients with 80 HCC nodules who received transarterial chemoembolization. Standard digital subtracted angiography (DSA) and CBCTA were systematically performed and analyzed. Three settings of the FPFL software for vascular tree segmentation were tested for each tumor: the default, Group D; adjusting the proportion of segmented tumor area between 30 to 50%, Group L; and between 50 to 80%, Group H. Results: In total, 109 feeder vessels supplying 80 HCC nodules were identified. The negative predictive value of DSA, FPFL in groups D, L, and H was 56.8%, 87.7%, 94.2%, 98.5%, respectively. The accuracy of DSA, FPFL in groups D, L, and H was 62.6%, 86.8%, 93.4%, 95.6%, respectively. The sensitivity, negative predictive value (NPV), and accuracy of FPFL were higher in Group H than in Group D (p = 0.041, 0.034, 0.005). All three segmentation sensitivity groups showed higher specificity, positive predictive value, NPV, and accuracy of FPFL, as compared to DSA. Conclusion: FlightPlan for Liver is a valuable tool for increasing detection of HCC tumor feeding vessels, as compared to standard DSA analysis, particularly in small HCC. Manual adjustment of segmentation sensitivity improves the accuracy of FPFL.

경경정맥 간내문맥 정맥단락술(TIPS)의 장기 개통성: 피막형과 비피막형 스텐트의 비교

주승문,박재형,김효철,제환준,정진욱 대한영상의학회 2009 대한영상의학회지 Vol.60 No.1

Purpose: To evaluate the long term patency of transjugular intrahepatic portosystemic shunts (TIPS) and to compare the patency rate of covered and uncovered stents in TIPS. Materials and Methods: The study population included 78 patients with portal hypertension that underwent TIPS between January 1999 and July 2007 at our institution using uncovered stents in 53 patients and covered stents in 25 patients. The primary and secondary patency rates of TIPS were estimated to compare the uncovered and covered stent groups. Results: The primary and secondary patency rates of the TIPS patients were found to be 83.9% and 93.9% at the 6 month follow-up and 73.5% and 88.5% at the12 month follow-up for uncovered and covered stents, respectively. A breakdown patency rates for the 12 month follow-up revealed that the primary patency rates were 76.6% and 66.3% for uncovered and covered stents, respectively; whereas, the secondary patency rates were 94.3% and 73.8% for the uncovered and covered stents, respectively. A comparative analysis did not provide evidence to suggest that a difference exists between the patency rates of the uncovered and covered stent groups (p>0.05). Conclusion: No significant difference was found between the patency rates of the uncovered and covered stent groups. A follow-up to this study would be a more thorough randomized evaluation of the different types of covered stents to compare long-term patency rates. 목적: 간내문맥 정맥단락술(TIPS)의 성적을 알아보고, 국내에서 사용되는 비피막형 스텐트와 피막형 스텐트의 개통률을 비교해 보고자 한다. 대상과 방법: 1999년 1월부터 2007년 7월까지 TIPS를 시행한 78명에서 53명이 비피막형 스텐트를 사용하였고, 25명이 피막형 스텐트를 사용하였다. TIPS의 일차 개통률과 이차 개통률을 Kaplan-Meier 방법으로 계산하였고, 비피막형 스텐트 군과 피막형 스텐트 군의 개통률에 차이가 있는지, Log-rank 테스트로 검증하였다. 결과: TIPS의 일차 및 이차 개통률은 6개월에 83.9%/93.9%, 1년에 각각 73.5%/88.5%이었다. 비피막형 스텐트 군과 피막형 스텐트 군을 비교하면 각각 1년 일차 개통률 및 이차 개통률은 76.6%/66.3%, 94.3%/73.8%로, 두 군의 개통률에 통계학적 차이는 없었다( p > 0.05). 결론: TIPS를 시행한 전체 환자의 개통률은 이전의 보고와 비교할 때 비교적 높았으나, 국내에서 사용되는 피막형 스텐트와 비피막형 스텐트 사이에는 통계학적인 차이가 없었다. 향후 피막형 스텐트의 종류에 따른 장기개통성에 관하여 추가적인 비교 연구가 필요할 것으로 보인다.

Percutaneous Transhepatic Biliary Drainage in a Two-Month-Old Infant with Inspissated Bile Syndrome

장성희,주승문,윤춘식,이광훈,이순민 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.7

Inspissated bile syndrome (IBS) is a relatively rare condition. Many treatment options are available, including medication, surgery,and surgical interventions, such as insertion of cholecystostomy drain, endoscopic retrograde cholangiopancreatography,internal biliary drainage, and percutaneous transhepatic biliary drainage (PTBD). We herein report the first case of IBS that wassuccessfully treated with PTBD in a two-month-old infant in Korea. PTBD was initiated on postnatal day 72. On postnatal day105, we confirmed complete improvement and successfully removed the catheters. This report suggests that PTBD is a viable andsafe treatment option for obstructive jaundice in very young infants

Conventional versus Drug-eluting Beads Trans-arterial Chemoembolization for Treatment of Hepatocellular Carcinoma at Very Early and Early Stages

이광훈,주승문,염태준,정상훈 대한간암학회 2017 대한간암학회지 Vol.17 No.2

Background/Aims: To retrospectively compare conventional and drug-eluting beads transarterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. Methods: We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child– Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student’s t-test for continuous variables and by chi-square test for categorical variables. Results: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001). Conclusions: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC.

Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study

김용표,함석진,이성수,이근동,주승문,염태준,이광훈 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.3

Objective: This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. Materials and Methods: From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16–64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. Results: Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients’ mean numeric pain intensity score was 2.4 (range: 0–5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3–13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. Conclusion: TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

Balloon-Supported Passage of a Stent-Graft into the Aortic Arch

은나래,이다혜,송석원,주승문,Tilo Kölbel,이광훈 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.4

A 62-year-old man was admitted, and thoracic endovascular aortic repair (TEVAR) procedure was performed to treat an accidentally detected aortic aneurysm, which was 63 mm in diameter. While performing TEVAR, the passage of the stentgraft introducer system was impossible due to the prolapse of the introducer system into a wide-necked aneurysm; this aneurysm was located at the greater curvature of the proximal descending thoracic aorta. In order to advance the introducer system, a compliant balloon was inflated. Thus, we created an artificial wall in the aneurysm with this inflated balloon. Finally, we were able to advance the introducer system into the target zone.

초기단계의 간세포암의 고식적 및 약물방출 경동맥화학색전술의 비교

이광훈 ( Kwang-hun Lee ),주승문 ( Seung-moon Joo ),염태준 ( Tae Jun Yum ),정상훈 ( Sang Hoon Jung ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2

Background/Aims: To retrospectively compare conventional and drug-eluting beads trans- arterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. Methods: We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child- Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student`s t-test for continuous variables and by chi-square test for categorical variables. Results: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001). Conclusions: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC. (J Liver Cancer 2017;17:144-152)

파열 간암의 간동맥 항암 화학색전술 후 발생한 유도 폐렴

김혜원,김용훈,윤홍진,이광훈,주승문,변민광,이정일,이관식,김자경 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.2

Transarterial chemoembolization (TACE) is a widely accepted nonsurgical modality used for the treatment of multinodular hepatocellular carcinoma (HCC). The careful selection of the candidate is important due to the risk of developing various side effects. Fever, nausea, abdominal pain, and liver enzyme elevation are commonly known side effects of TACE. Hepatic failure, ischemic cholecystitis, and cerebral embolism are also reported, although their incidence might be low. Pulmonary complication after TACE is rare, and the reported cases of lipiodol pneumonitis are even rarer. A 53-year-old man was treated with TACE for ruptured HCC associated with hepatitis B virus infection. On day 19 after the procedure, the patient complained of dyspnea and dry cough. Chest computed tomography showed diffuse ground glass opacities in the wholelung fields, suggesting lipiodol-induced pneumonitis. After 2 weeks of conservative management, the clinical symptoms and radiologic abnormalities improved. Reported herein is the aforementioned case of lipiodol-induced pnemonitis after TACE, with literature review.

Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

이윤진,김영훈,이경호,박지훈,이혜승,정승채,주승문 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1

Objective: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. Materials and Methods: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. Results: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. Conclusion: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.