총 담관 결석 평가에서 디지털 단층영상합성법과 내시경적 역행성 담췌관 조영술의 비교 연구

The purpose of our study was to compare the digital tomosynthesis with endoscopic retrograde cholangiopancreatography (ERCP) to evaluate common bile duct (CBD) stones as a complementary diagnostic tool. The study population consisted 96 consecutive patients clinically suspected of having CBD stones underwent ERCP and digital tomosynthesis during 22 months, from December, 2008 to May, 2010. Fourteen patients were excluded. Therefore 82 patients were included in this study. The images were retrospectively reviewed to compare the results, with the final analysis based on the consensus of two abdominal radiologists. An evaluation of the presence of CBD stones was followed by a determination of the margins of the stones, as scored with a five-point conspicuity scale. The gold standard for stone detection was the results of stone-removal procedure. Among eighty two patients, 54 patients had 89 CBD stones and 28 patients had no stones. The sensitivity and specificity to detect CBD stones were 91.0% and 80.6% for ERCP, 92.1% and 93.5% for digital tomosynthesis. The average score was 3.3 ± 0.9 for ERCP and 3.9 ± 0.9 for digital tomosynthesis in 77 concurrently detected stones. Digital tomosynthesis demonstrated better conspicuity than ERCP, with a statistically significant difference between the two methods (p=0.001). In conclusion, digital tomosynthesis is an effective and complementary diagnostic method to evaluate the CBD stones. Therefore, digital tomosynthesis is helpful in deciding the endoscopic stone removal procedure during ERCP.;본 연구에서는 총 담관 결석 평가에 디지털 단층영상합성법(digital tomosynthesis)과 내시경적 역행성 담췌관 조영술(endoscopic retrograde cholangiopancreatography)의 상호 보완적인 진단 방법으로서의 가치를 비교하고자 하였다. 2008년 12월부터 2010년 5월까지 내시경적 역행성 담췌관 조영술과 디지털 단층영상합성법을 동시에 시행한 환자 중, 총 담관 결석 증상이 의심되는 96명의 환자를 대상으로 하였다. 이 중 14명이 제외되어 82명의 환자가 연구에 포함되었다. 두 명의 복부 영상의학과 의사가 내시경적 역행성 담췌관 조영술과 디지털 단층영상합성법 영상을 후향적으로 분석하였다. 먼저 총 담관 결석의 유무를 평가하였고, 두 검사 방법에서 동시에 결석이 발견된 경우에는 결석의 경계를 1점에서 5점으로 척도를 정하여 분석하였다. 82명의 환자 중 54명의 환자가 89개의 총 담관 결석이 있었으며 28명의 환자는 결석이 없었다. 총 담관 결석 진단에서 내시경적 역행성 담췌관 조영술의 민감도, 특이도는 91.0%, 80.6%이며 디지털 단층영상합성법은 92.1%, 93.5%였다. 두 진단 방법에서 동시에 발견된 77개의 총 담관 결석 경계의 정확도에 대한 평균 점수는 내시경적 역행성 담췌관 조영술에서 3.3이며 디지털 단층영상합성법에서 3.9였다. 총 담관 결석 경계의 정확도는 디지털 단층영상합성법에서 통계적으로 유의하게 높았다(p =0.001). 결론적으로, 총 담관 결석을 평가하는데 있어 디지털 단층영상합성법은 효과적이며 상호 보완적인 진단 방법이 될 수 있다. 따라서, 내시경적 역행성 담췌관 조영술을 시행하는 현장에서 총 담관 결석에 대한 내시경 치료 여부를 결정하는데 디지털 단층영상합성법은 결정적인 도움이 된다.I. Introduction 1 II. Materials and Methods 4 A. Patients selection 4 B. Imaging technique 4 C. Imaging analysis 5 D. Statistical Analysis 6 III. Results 7 IV. Discussion 9 V. Conclusion 14 Table 15 Figures 18 References 24 국문초록 2

Gadoxetate dynamic contrast-enhanced MRI and ultrasonographic shear wave elastography for evaluation of liver function and fibrosis in preclinical trial

Objective: Non-invasive imaging evaluation of the liver fibrosis and liver function has huge emphasis currently when huge efforts have garnered to develop new drug for liver fibrosis and chronic liver disease. Shear wave elastography (SWE) and gadexetate-enhanced DCE-MRI have been utilized in clinical researches, however rarely used in preclinical trial due to lack of validation. In this regard, we aim to validate the SWE and gadoxetate-enhanced DCE-MRI in an animal model of liver fibrosis. Methods: Thirty-one SD rats were randomly assigned into three groups (high-dose, low-dose, and control). The liver fibrosis was induced in SD rats by administration of thioacetamide intraperitoneally for 8 weeks: 200mg/kg for high-dose group and 150 mg/kg for low-dose group. At the end of thioacetamide administration period, we performed SWE twice with two days interval and performed gadoxetate-enhanced DCE-MRI. Liver stiffness in kPa was measured in the SWE. Five DCE-MRI indices (RLE-3, RLE-15, iAUC-3, iAUC-15, Emax) were calculated using MATLAB-based software. The correlation between these imaging parameters and histopathologic results and indocyanine green (ICG) R15 test results were calculated. The diagnostic performance to diagnose liver fibrosis was also evaluated. Results: On histopathology, animal model was successful in that the collagen areas was highest in high-dose group (24.86 ± 4.55), followed by low-dose group (16.01 ± 3.25), and control group (6.27 ± 2.10). The correlation between the histopathologic collagen area and imaging parameters was similarly high in iAUC-15, iAUC-3, and RLE-3 (-0.78 to -0.81), but low in RLE-15 (-0.51) and liver stiffness in kPa (-0.59). The correlation coefficients between MRI indices and liver function on ICG-R15 was highest in iAUC-15 (-0.65) followed by iAUC-3 (-0.63), RLE-3 (-0.62), Emax (-0.58), and RLE-15 (-0.56). In the ROC analysis to diagnose liver fibrosis (i.e., high-dose group and low-dose group), the diagnostic accuracy of RLE-3, iAUC-3, iAUC-15, and Emax were 100% (AUROC 1.000) with complete differentiation between the liver fibrosis groups and control group. In contrast, the diagnostic value of the RLE-15 was significantly lower than the other MRI indices (AUROC 0.777) Conclusions: Theoretically, the ultrasonographic SWE reflects liver fibrosis and the gadoxetate-enhanced DCE-MRI reflects liver function. In our study using the animal liver fibrosis model, the ultrasonographic SWE and gadoxetate-enhanced DCE-MRI are quite feasible to evaluate both histopathologic liver fibrosis and physiologic liver function in non-invasive manner in preclinical trial.Docto