Jeon Pyoung

학위논문(박사)--아주대학교 일반대학원 :의학과,2009. 8국문요약 ⅰ 차례 ⅲ 그림 차례 ⅳ 표 차례 ⅵ Ⅰ. 서론 1 Ⅱ. 연구대상 및 방법 4 A. 연구대상 4 B. 연구방법 6 1. 산화망간 나노입자 조영제 6 2. 영구폐색 국소 뇌허혈 동물모델 8 3. 산화망간 나노입자 조영제를 이용한 자기공명영상 10 4. 시간에 따른 신호 대 잡음비의 측정 11 5. H & E 염색 13 6. TUNEL 염색 13 7. 통계분석 14 Ⅲ. 결과 15 A. 중뇌동맥 폐색 후 흰쥐의 MONEMRI 영상소견 15 B. 뇌경색 이후 각 영역별 신호 대 잡음비의 시간에 따른 변화 25 C. 뇌손상 조직의 H&E 염색표본과 MR영상 비교 28 D. 뇌손상 조직의 TUNEL 염색표본과 MONEMRI 비교 32 Ⅳ. 고찰 35 Ⅴ. 결론 38 참고문헌 39 ABSTRACT 44|그림 차례 Fig. 1. Schematic diagram of study protocol 5 Fig. 2. A manufacturing process of MnO nanoparticle 7 Fig. 3. Anatomy structure of cerebral artery in rat brain 9 Fig. 4. Localization of selected ROIs for SNR measurement 12 Fig. 5. Coronal T1 images at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 17 Fig. 6. Coronal T2 images at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 18 Fig. 7. Coronal diffusion-weighted images(DWI) at pre- occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 19 Fig. 8. Coronal T2* images at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 20 Fig. 9. Coronal MnO enhanced T1 images at pre- occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 21 Fig. 10. Coronal T2 images of MONEMRI at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 22 Fig. 11. Coronal DWI of MONEMRI at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 23 Fig. 12. Coronal T2* of MONEMRI at pre-occlusion, 3hrs, 6hrs, 24hrs, 72hrs and 1wk after the occlusion of right MCA in rat 24 Fig. 13. Serial SNR of cerebral cortex, basal ganglia and peripheral zone of infarcted area 26 Fig. 14. Comparing of coronal MnO enhanced T1 image and corresponding H&E stained slide in rat brains after 3hrs, 6hrs, 24hrs, 72hrs and 1wk 29 Fig. 15. Hematoxylin and eosin staining of the ischemic injure brain 31 Fig. 16. In situ detection of apoptoic cell death after MCA occlusion 33 Fig. 17. High magnification of TUNEL positive cell. 34 |표 차례 Table 1. Serial SNR of cerebral cortex and basal ganglia 27Maste

Beam hardening artifact in follow-up CT after TAE in hepatocellar carcinoma

의학과/석사[한글] 간세포암에서 간동맥 화학색전술 후 시행한 복부 전산화 단층촬영에서 간동맥 화학색전 치료시 주입한 리피오돌(lipiodol)이 종양내 분포하는 정도와 양상이 종양의 괴사 정도와 밀접한 상관 관계가 있다는 사실은 알려져 있다. 간동맥 화학색전술 후 복부 전산화 단층촬영에서 종양내 집적(accumulation)된 리피오돌에 의하여 beam hardening artifact가 일부에서 관찰되는 데 이러한 beam hardening artifact가 종양의 치료에 대한 반응과 예후를 예측할 수 있는 인자가 되는지 알아보고자 하였다. 1990년 1월부터 1994년 12월까지 간동맥을 통한 화학색전 치료를 시행 받은 91명의 123병소를 대상으로 복부 전산화 단층촬영 소견을 조사하였으며 그 결과는 다음과 같다. 1. 리피오돌이 종양내 집적되는 양상을 살펴본 결과 완전 집적이 75병소(55)이었고 부분 집적이 48병소(36명)이었으며, 리피오돌의 완전 집적을 보인 75병소 중 beam hardening artifact가 관찰된 경우가 36병소 이었으며 관찰되지 않은 경우가 39병소이었다. 2. Beam hardening artifact가 보였던 36개의 병소의 치료 전에 대한 치료후의 용적 비율은 66±11%로 beam hardening artifact가 관찰되지 않았던 39개 병소의 용적 비율인 74±12%보다 통계적으로 유의한 감소를 보였다 (p < 0.05). 3, 간동맥 화학색전술 후 수술한 10개의 병소의 병리학적 소견을 살펴보면 리피오돌의 완전 집적이 나타난 8개의 병소는 거의 전부가 괴사를 일으킨 반면, 부분 집적만 일어난 2개의 병소는 괴사가 일어나지 않은 부분이 관찰되었다. 4. 간동맥 화학색전술 후 추적 복부 전산화 단층촬영에서 재발 양상을 살펴본바 부분 집적을 보였던 군에서는 70%(34/48)에서 종양내 리피오돌의 집적이 없는 부위에서 종양의 성장을 보였다. 리피오돌이 완전 집적된 결절형 종양 75개의 병소중 8개의 병소에서 간세포암의 재발을 볼 수 있었으며, beam hardening artifact가 있던 3개의 병소에서 종양의 재발이 관찰되었고 beam hardening artifact가 없는 5개의 병소에서 재발이 관찰되었다. 전체 대상 환자 91명중 28명에서는 이전 복부 전산화 단층촬영에서 보이지 않던 또 다른 결절형 간세포암이 관찰되었다. [영문] TAE is generally considered to be an effective form of treatment in hepatocellular carcinoma (HCC). Histopathologic studies have shown a close correlation between Lipiodol accumulation and tumor necrosis in HCC after TAE. We occasionally observed beam hardening artifact in tumors with complete Lipiodol retention. In present study, we correlated beam hardening artifact in follow-up CT studies after TAE for HCC. We retrospectively studied 123 lesions of 91 patients with single nodular or multinodular HCC less than 3 in number. The results were as follows. 1. Patterns of Lipiodol accumulation within tumors were classified in 2 groups: complete and incomplete accumulation. Complete accumulation was observed in 61%. 2. Beam hardening artifact was observed in 48% of complete Lipodol accumulation. The volume ratio of tumor was 66.3± 11.3% in the groups with beam hardening artifact, 74.3± 10.3% in that without beam hardening artifact. The difference between two groups was statistically significant(p<0.05). 3. 8 tumors with complete Lipiodul accumulation had total or near total necrosis. 2 tumors with incomplete Lipiodol accumulation had 75%necrosis. 4. The rate of local recurrencc was significantly higher in incomplete accumulation (70%) than in complete accumulation (11%). In terms of beam hardening artifact local recurrence was observed in 3 tumors among the groups with beam hardening artifact and 5 tumors among that without beam hardening artifact. In conclusion, beam hardening artifact with complete accumulation of Lipiodol in the tumor on follow-up CT tends to correlate with decreasing tumor volume, complete tumor necrosis.restrictio

Management of Asymptomatic Carotid Stenosis for Primary Stroke Prevention: 2012 Focused Update of Korean Clinical Practice Guidelines for Stroke

Extracranial carotid stenosis is a well-established, modifiable risk factor for stroke. Asymptomatic extracranial carotid stenosis is increasingly being detected due to the introduction of less-invasive and more-sensitive advanced diagnostic technologies. For severe asymptomatic stenosis, earlier pivotal clinical trials demonstrated the benefit of carotid endarterectomy over the best medical therapy. Since then, great advances have been made in interventional and medical therapies as well as surgical techniques. The first edition of the Korean Stroke Clinical Practice Guidelines for primary stroke prevention for the management of asymptomatic carotid stenosis reflected evidences published before June 2007. After the publication of the first edition, several major clinical trials and observational studies have been published, and major guidelines updated their recommendation. Accordingly, the writing group of Korean Stroke Clinical Practice Guidelines (CPG) decided to provide timely updated evidence-based recommendations. The Korean Stroke CPG writing committee has searched and reviewed literatures related to the management of asymptomatic carotid stenosis including published guidelines, meta-analyses, randomized clinical trials, and nonrandomized studies published between June 2007 and Feb 2011. We summarized the new evidences and revised our recommendations. Key changes in the updated guidelines are the benefit of intensive medical therapy and further evidence of carotid artery stenting as an alternative to carotid endarterectomy. The current updated guidelines underwent extensive peer review by experts from the Korean Stroke Society, Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, Korean Society of Cerebrovascular Surgery, and Korean Neurological Association. New evidences will be continuously reflected in future updated guidelines.N