Interventional radiological approaches to non-variceal gastrointestinal bleeding

권세환,Seung Yeon Noh,Joo Hyeong Oh 소화기인터벤션의학회 2023 International journal of gastrointestinal interven Vol.12 No.1

Although many cases of gastrointestinal bleeding (GIB) respond to medical and endoscopic management, GIB is often a serious clinical dilemma. Massive GIB can lead to significant morbidity and mortality unless appropriate treatment is not performed. Diagnostic and therapeutic approaches to GIB depend on its location, severity, and etiology. Interventional radiological management (intra-arterial infusion of vasopressin and transcatheter arterial embolization) is a safe and effective minimally invasive alternative to surgery for the management of GIB that is refractory to endoscopic treatment. The present review discusses the essential role of interventional radiology in the management of GIB.

골반 외상 인터벤션

Jung Han Hwang,Jeong Ho Kim,Suyoung Park 대한영상의학회 2023 대한영상의학회지 Vol.84 No.4

Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%– 54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%–20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques. 골반 외상은 대부분 고에너지 손상을 동반하며, 이에 따른 치명률 및 사망률이 높은 편이다. 관련된 출혈은 대부분 골반내 정맥이 손상되거나 해면골이 골절되어 발생하고 혈종에 의해안정화되지만, 10%–20%에서 동맥 출혈이 동반되며, 골반 용적이 증가된 상태에서 동맥 출혈이 지속된다면 이로 인한 사망률은 36%–54%까지 증가한다. 골반의 해부학적 구조상 다양하고 풍부한 혈관이 분포되어 있고, 골반 외상 환자 대부분이 많은 양의 혈종을 동반하기때문에, 수술적 치료는 시야 확보의 어려움과 눌림 효과에 따른 지혈효과를 없애 출혈을 더조장할 수 있어, 1차적으로 인터벤션 치료가 권고되고 있다. 또한 출혈의 위치가 대부분 골절된 부분이기 때문에 CT를 통해 시술 전 출혈 부위를 특정하여 빠른 시간 내에 출혈에 대한 색전술을 시행할 수 있다. 이처럼 올바른 진단과 치료를 동시에 할 수 있다는 장점으로 인해 골반 외상 환자에 있어 인터벤션 치료는 중추적인 역할을 담당하고 있다. 본 연구에서는 문헌고찰을 통해 골반 외상에 대한 올바른 진단 및 인터벤션 치료의 유용성과 고려 사항에 대해알아보고자 한다.

두 개강내 동정맥 기형의 Stereotactic Radiosurgery 치료효과의 평가를 위한 영상진단: 예비보고

유정식 대한영상의학회 1991 대한영상의학회지 Vol.27 No.6

To evaluate the therapeutic effect of sterotactic radiosurgery(RS) of intracranial arteriovenous malformations(AVMs) and to observe the detailed changes in and around the lesions after this treatment method, we reviewed and compared the angiographic and CT findings of 6 patients examined before and 6 to 19 months after treatment with this high energy photon beam radiotherapy by linear accelerator through the sterotactic method. Four out of 6 patients(67%) with small AVMs(1.0-2.7cm3) showed significant reduction in volume more definitely on the angiograms(8%-48%) than the CT scan images, but both diagnostic modalities were able demonstrate the efficacy of steretactic radiosurgery in the treatment of intracranial AVMs. Angiograms also to demonstrated delayed blood flow and decreased size of major draning veins in 3 patients and a small focal vascular defect in another patient with minimal volume change which were not detected in CT images. Angiography proved to be a more reliable imaging technique than CT for the follow-up of these lesions.

척추의 전이암: 노발리스 방사선 수술 후의 자기공명영상소견

황윤준,손문준,황충진,이동준,허감,차순주,김용훈,김수영,서정욱,한윤희,김미영 대한영상의학회 2006 대한영상의학회지 Vol.55 No.5

Purpose: To assess the therapeutic effect of Novalis radiosurgery for metastatic spinal tumors and evaluate the changes after treatment using MR imaging. Materials and Methods: Between November 2003 and June 2005, 21 patients with metastatic spinal tumors underwent Novalis radiosurgery. Of these patients, the 7 with 13 metastatic spinal tumors who had undergone follow-up MR imaging were included in this study. The tumor locations were cervical spine in three, thoracic spine in four, lumbar spine in five and sacrum in one. During the first three months after Novalis radiosurgery, follow-up MRI was performed monthly and subsequently at 3-6-month intervals. On MR imaging, the volume of the tumors, the changes of their signal intensities and any changes in adjacent spinal cord were evaluated. Results: Among the 13 lesions, 9 were decreased in volume (69.2%), 2 were stable (15.4%) and 2 were slightly increased. Seven of 9 lesions showed decreased signal intensity on T2 weighted images and 4 had compressive deformity. Two of 9 lesions had increased T2 signal intensity and tumor necrosis were detected on contrast-enhanced MR imaging. No changes in spinal cord were noted in any of the lesions. Those changes were detected on MRI obtained 1 month after Novalis surgery and the lesion sizes were gradually changed up to 3 months. Conclusion: Novalis radiosurgery was effective for the treatment of metastatic spinal tumor and the suppression of tumor growth. The estimation of therapeutic effect and detecting complication were precisely evaluated on MR imaging. 목적: 척추의 전이암 환자에 있어서 노발리스 방사선 수술을 시행한 후 자기공명영상을 통하여 전이암의 변화를 알아보고자 한다. 대상과 방법: 노발리스 방사선 수술을 시행한 척추의 전이암 환자 21명 중 자기공명영상으로 추적 관찰이 가능하였던 7명의 환자에서 총 13개의 병변을 대상으로 하였다. 병변의 위치는 경추 3개, 흉추 4개, 요추 5개, 천추 1개였다. 노발리스 방사선 수술 후 첫 3개월간은 매달 자기공명영상으로 추적 관찰하였고 그 이후에는 3개월-6개월 마다 관찰하였다. 자기공명영상을 통하여 병변의 체적 및 신호강도의 변화를 관찰하였고 인접한 척수의 변화 유무도 관찰하였다. 결과: 총 13개의 병변 중 체적이 감소한 예가 9병소(69.2%), 변화가 없었던 예가 2병소(15.4%)였고, 2병소(15.4%)에서는 약간 증가하였다. 병변의 체적이 감소한 9병소 중 7병소에서 T2신호강도가 감소하였고 그 중 4병소에서는 압박 변형을 동반하고 있었다. 나머지 2병소에서는 T2 신호강도 증가 소견을 보였고 조영증강영상에서 병변의 괴사가 관찰되었다. 척수는 전 예에서 변화를 보이지 않았다. 이러한 변화들은 노발리스 방사선수술 후 1개월 후에 시행한 자기공명영상에서 관찰할 수 있었고 병변의 체적은 추적관찰 영상에서 더욱 감소하였다. 결론: 노발리스 방사선 수술은 척추 전이암의 치료 및 성장 억제에 유용하였고 자기공명영상을 통하여 치료 효과 판정 및 합병증 발병 유무를 정확히 관찰할 수 있었다.

간암의 경 동맥 화학색전술

박병호 동아대학교의과대학 1992 동아의대학술지 Vol.4 No.1

수술이 불가능한 췌장암에 대한 고강도집속초음파 응고술(하이프)

송인호,정승은,한성태,장진희,조세현,한준열,김진일,이지영,성춘호 대한영상의학회 2007 대한영상의학회지 Vol.56 No.6

Purpose: We wanted to evaluate the levels of effect and safety of high-intensity focused ultrasound ablation (HIFU) for treating patients with advanced pancreatic cancer. Materials and Methods: Nineteen sessions of HIFU, with the patients under general anesthesia, were performed in 18 patients with advanced pancreatic cancer. The change of the gray-scale of the target lesion was analyzed during HIFU, and MRI was performed before and after HIFU. We assessed the extent of coagulative necrosis, the change of pain and the complications after HIFU. The change of tumor size and the survival of patients were also evaluated. Results: The average size of tumor was 4 cm in diameter. Eighty nine percent of the target tumors showed increased echogenicity. On MRI, necrosis of the entire target tumor occurred in 79% of the patients. After treatment, effective pain relief was noted in 89% of the patients. There were no major complications. No size increase of the treated tumor was noted during 24 weeks of follow-up for 10 patients. Six patients among 12 patients who were available for follow-up are still alive and they are receiving chemotherapy. Six patients expired due to other disease or progression of metastasis. Conclusion: HIFU is a safe method without any major complications, and it is effective for inducing tumor necrosis and achieving pain control for patients with advanced pancreatic cancer. 목적: 수술이 불가능한 췌장암에서 고강도집속초음파응고술(high-intensity focused ultrasound system, HIFU, 하이프)의 효과와 안전성을 알아보고자 한다. 대상과 방법: 수술이 불가능한 췌장암으로 진단받은 18명의 환자에서 전신 마취하에 19번의 하이프 시술을 하였다. 치료 중 초음파로 치료 구역의 회색도 변화를 분석하였다. 시술 전후에 MRI를 시행하여 응고괴사범위를 치료계획 범위와 비교하였다. 시술 전후 췌장암으로 인한 통증의 변화를 분석하였고, 합병증의 유무를 확인하였으며 추적 검사를 통해 췌장암 종괴의 크기변화와 환자의 생존 여부를 알아보았다. 결과: 종괴의 시술 전 크기는 최대 지름이 평균 4 cm이었다. 치료 중 초음파에서 치료 구역의 고에코의 회색도 변화는 89%에서 나타났다. 2주 후 추적 MRI 영상에서 79%에서 치료계획 범위 전체가 응고괴사되었다. 89%에서는 시술 후 통증이 경감하거나 소실되었다. 시술 후 경미한 합병증은 있었으나, 중대한 합병증은 없었다. 두 번 이상 영상 추적검사를 시행한 10명의 환자에서 추적 검사기간은 평균 24주였고, 치료한 종양의 크기 증가는 뚜렷하지 않았다. 추적검사가 가능했던 12명의 환자에서 현재 6명의 환자가 항암치료를 받으며 생존해 있다. 하이프치료 후 사망한 6명은 다른 질환이나, 전이암이 진행되어 사망하였다. 결론: 수술이 불가능한 췌장암에서 하이프 시술은 종양의 응고 괴사와 통증 조절에 효과적이며, 중대한 합병증이 없는 안전한 방법이다.

대한방사선종양학회지의 학술민용 변화 추이 및 학술 영향력 지수 개선을 위한 제안

김성환(Seong Hwan Kim),황성수(Seong Su Hwang),안명임(Myeong Im Ahn),정소나(Sona Jeong) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.4

목 적 최근 6년킨 한국의학학술지 인용색인 정보 (KoMCI)를 분석하여 대한망사선증앙학회지의 학술 인용 추이를 알아보고 학술지 영향력 지표OFI 개선방안을 찾아보고자 하였다. 대상과 방법 2000년에서 2005 년까지 KoMCI 자료에서 대한방사선좀앙학회지의 연간 게재 논문 수, 인용한 국내외 참고 문현 수, 자체 및 타 학술지의 인용 빈도, 대한방사선증앙학회지를 인용한 다른 국내 학술지 종류, IF 및 자체 학술지 인용를 제외한 영향력 지수 (ZIF) 등의 변화를 알아보고, 이를 K야AC기 등재 국내 학술지 평균과 비교하여 학술 인용 색인 추이 번화 앙상의 차이를 살펴보고 IF 개선을 위한 방안을 찾아보았다. 결 과 연간 게재 놈문 수의 감소는 국내 학숱지 전반에 걸쳐 공룡된 현상이었고, KoACI 등재 국내 학숱지 평균에서는 32%, 대한방사선증앙학힐지에시는 최대 38%의 감소 추세였다 논문당 국내 논문 인용빈도는 KoMCI 학술지 평균치는 2.0편에 비해 조금 낮은 1. 6편이었다 대한방사선종앙학회지의 놈문당 전체 발간 논문에 대한 인용 빈도는 1.333으로 KoMCI 학술지 평균 1.694에 비해 낮았으나, 2000년의 1,000 에 비해 20005 년에는 1.670으로 67% 증가하였다 논운당 자체 학술지 인용은 KaMCI 학술지 명란에서는 전체 인용빈도으 161% 였으니, 대한방사선종앙학회지 에서는 72%로 초금 더 높았다 6년간 대한방사선증앙학회지의 IF값은 2000 년의 0.144에서 2000년 0.107까지 감소후 2005 년에는 0.203으로 개선되었다 자체 학슬지 인용을 배제한 긴F값은 2004년의 0.044를 제외하고 2000 년의 0.038에서 2005 년의 0.013으로 감소 경향이었다. 결 론 대한방사선증앙학회지의 IF는 점진적 개선되고 있으나 매우 작은 인용빈도를 바탕으로 산출된 한계가 있다. 자체 학술지 인용를 보다 적극적으로 확대하고 타 학술지굳부터의 인용증대을 위한 노력(교차인용 학대 및 영문 논문 게재 증가) 들이 지속적인 학회지의 IF 개선에 필요하며 이를 위해 학회 회원들의 학술지 IF 중요성 인식 및 개선에 대한 적극적인 홍보 노력이 요구된다. purpose: To analyze the recent citation trend and to find a way to improve impact factor (IF) of the Journal of Korean Therapeutic Radiology and Oncology (JKSTRO) by analysis of Korean Medical Citation Index(KoMCI) citation data of JKSTRO and comparison with that of mean citation data of all journals enlisted on KoMCI (KoMCI journals) during 2000-2005. Materials and Methods: All citation data of entire Journals enlisted on KoMCI and JKSTRO tram 2000 to 2005 were obtained from KoMCI. The trend of total and annual number of published articles and reference citations, total citations and self-citations per paper, IF and Impact factor excluding self-citations (ZIF) were described and compared on both KoMCI journals and JKSTRO Results: Annual number of published articles was decreased for 6 years on both KoMCI journals and JKSTRO (32% and 38% reduction rate). The number of Korean journal references per article is 1.6 papers on JKSTRO comparing to 2.0 papers on KoMCI journals. The percentage 이 Korean References/total references Increased from 5.0% in 2000 to 7.7% in 2005 on JKSTRO and from 8.5% in 2000 to 10.1% on KoMCI journals. The number of total citations received/paper on JKSTRO (average 1.333) is smaller than that of KoMCI journals (average 1.694), there was an increased rate of 67% in 2005 comparing to 2000. The percentage of self-citations/total citations (average 72%) on JKSTRO is slightly higher than that of KoMCI journals (average 61%1. IF of JKSTRO was gradually improved and 0.144, 0.125, 0.088, 0.107, 0.187, and 0.203 in 2000-2005 respectively However, ZIF of JKSTRO is steadily decreased from 0.038 in 2000 to 0.Ot3 in 2005 except 0.044 in 2004 conclusion: IF of JKSTRO was slightly improved but had some innate problem of smaller number of citations received. To make JKSTRO as a highly cited journal, the awareness of academic status of JKSTRO and active participation of every member of JKSTRO including encouraging elf-citations of papers published recent 2 years and submission of English written papers, and active academic cooperation with related academic societies

방사선 치료에 따른 99mTc - pertechnetate를 이용한 이하선과 악하선 기능 검사의 유용성

홍인수(In Soo Hong),성기준(Ki Joon Sung),김명순(Myung Soon Kim),김종진(Jong Jin Kim),이종영(Jong Young Lee),박진숙(Jin Sook Park) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.3

N/A Purpose: To assess the functional change of salivary gland, recovery of salivary destruction, difference of susceptibility to irradiation between the parotid and submandibular gland, correlation between the xerostomia and excretory rate by irradiation in salivary Tc-99m-pertechnetate in patients with head and neck cancer. Materials and Methods: We evaluated 19 patients with head and neck cancer who Tc-99m-pertechnetate salivary gland scan before, during and after radiotherapy. We measured the uptake of radioactivity every 5 minutes for 60 minutes after injection of Tc-99m-pertechnetate(370MBq). We also evaluated the first excretory function stimulated by 5% citric acid at 30 minutes after injection of Tc-99m-pertechnetate and then the second excretory function stimulated by 10% citric acid at 45 minutes. Results: The mean uptake curves showed a sharp increase at the 1st week of radiotherapy and then showed a gradual decrease afterwards during radiotherapy. And the mean uptake curves after radiotherapy persistently decreased on follow up scans without being recovered. The excretory rates decreased gradually as radiation dose increased and were not recovered after radiotherapy. Our study was not satisfactory enough to show the difference of susceptibility to irradiation between the parotid and salivary gland and the correlation between the symptom of xerostomia and the change of the excretory rates. Conclusion: The parotid and submandibular gland scans using Tc-99m- perechnetate are useful in the assessment of the functional change of the salivary gland by radiotherapy and predicted the functional change of the salivary gland until 1 year-follow up scan. KW: Salivary gland abnormality, Salivary gland, radionuclide studies, Salivary gland, therapeutic radiology, Tc-99m-pertechnetate

Interventional management for postoperative arterial bleeding in gastrointestinal surgery

Yozo Sato,Kiyoshi Matsueda,Marie Osawa,Yoshitaka Inaba,Yu Takahashi,Yosuke Inoue,Atsushi Oba,Yosuke Fukunaga,Yasuhiro Shimizu 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4

Postoperative arterial bleeding after gastrointestinal surgery is a potentially fatal complication. Transcatheter arterial embolization is considered the first-line treatment because of efficacy and less invasiveness despite the risk of organ infarction. With the recent advances in endovascular devices, stent-graft placement, which can preserve arterial flow, has been an alternative treatment option in patients with extrahepatic artery hemorrhage. Moreover, clinical outcomes of stent-graft placement for pseudoaneurysms in relative long term have been reported recently. Herein, we review the techniques and clinical outcomes for interventional management for postoperative arterial bleeding.

Gastroduodenal artery steal syndrome treated with coil embolization after orthotopic liver transplantation

James Vu,Jesus Beltran-Perez,Bruce Bordlee 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.3

Gastroduodenal artery steal syndrome is an uncommon complication occurring after orthotopic liver transplantation (OLT) that results in hypoperfusion of the hepatic artery increasing the risk for graft dysfunction. Its non-specific clinical and imaging findings often delay diagnosis and increase the chance for re-transplantation or death. The lack of diagnostic criteria and definitive risk factors for developing the syndrome creates a need for angiography to visualize anatomical and perfusion characteristics indicative of the phenomenon. We present a 47-year-old male who underwent OLT and developed gastroduodenal artery steal a week after surgery. The diagnosis was confirmed with angiogram and successfully treated with coil embolization of the gastroduodenal artery. Arterial steal syndromes should be part of the broad differential when encountered with findings suggestive of an arterial complications in post-OLT patients.