• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.950-956
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• 2021

Objective : Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI). Methods : Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm²/m²). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS). Results : A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm², p=0.028) and PMI (5.9 vs. 5.1 cm²/m², p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535-0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study. Conclusion : Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1187-1195
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• 2018

Objective: To compare correlations between pulmonary function test (PFT) results and different reconstruction algorithms and to suggest the optimal reconstruction protocol for computed tomography (CT) quantification of low lung attenuation areas and airways in healthy individuals. Materials and Methods: A total of 259 subjects with normal PFT and chest CT results were included. CT scans were reconstructed using filtered back projection, hybrid-iterative reconstruction, and model-based IR (MIR). For quantitative analysis, the emphysema index (EI) and wall area percentage (WA%) were determined. Subgroup analysis according to smoking history was also performed. Results: The EIs of all the reconstruction algorithms correlated significantly with the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) (all p < 0.001). The EI of MIR showed the strongest correlation with FEV1/FVC (r = -0.437). WA% showed a significant correlation with FEV1 in all the reconstruction algorithms (all p < 0.05) correlated significantly with FEV1/FVC for MIR only (p < 0.001). The WA% of MIR showed the strongest correlations with FEV1 (r = -0.205) and FEV1/FVC (r = -0.250). In subgroup analysis, the EI of MIR had the strongest correlation with PFT in both eversmoker and never-smoker subgroups, although there was no significant difference in the EI between the reconstruction algorithms. WA% of MIR showed a significantly thinner airway thickness than the other algorithms ($49.7{\pm}7.6$ in ever-smokers and $49.5{\pm}7.5$ in never-smokers, all p < 0.001), and also showed the strongest correlation with PFT in both ever-smoker and never-smoker subgroups. Conclusion: CT quantification of low lung attenuation areas and airways by means of MIR showed the strongest correlation with PFT results among the algorithms used, in normal subjects.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.234-241
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• 2019

Background: The utility of computed tomography (CT) in the differential diagnosis of patients with chronic obstructive pulmonary disease (COPD) exacerbation remains uncertain. However, due to the low cost associated with CT scan along with the impact of Koreas' health insurance system, there has been a rise in the number of CT scans in the patients with initial diagnosis of COPD exacerbations. Therefore, the utility of CT in the differential diagnosis was investigated to determine whether performing CT scans affect the clinical outcomes of the patients with an initial diagnosis of COPD exacerbation. Methods: This study involved 202 COPD patients hospitalized with an initial diagnosis of COPD exacerbation. We evaluated the change in diagnosis or treatment after performing a CT scan, and compared the clinical outcomes of patient groups with vs. without performing CT (non-CT group vs. CT group). Results: After performing CT, the diagnosis was changed for two (3.0%) while additional diagnoses were made for 27 of the 64 patients (42.1%). However, the treatment changed for only one (1.5%), and six patients (9.3%) received supplementary medication. There were no difference in the median length of hospital stay (8 [6-13] days vs. 8 [6-12] days, p=0.786) and intensive care unit care (14 [10.1%] vs. 11 [16.7%], p=0.236) between the CT and non-CT groups, respectively. These findings remained consistent even after the propensity score matching. Conclusion: Utility of CT in patients with acute COPD exacerbation might not be helpful; therefore, we do not recommend chest CT scan as a routine initial diagnostic tool.

• 한국방사선학회논문지
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• 제16권7호
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• pp.889-896
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• 2022

본 연구는 전산화단층촬영의 테이블에 에어 매트리스의 적용으로 인한 환자의 주관적 편안함의 변화를 설문지를 통하여 분석하고, 환자의 임상 영상을 정량적 정성적 평가를 통하여 화질 변화를 분석하여 에어 매트리스의 유용성을 평가하고자 하였다. 연구에 참여한 피험자는 남성이 221명, 여성이 229명이었으며, 연령 범위는 만 18세에서 86세이다. 영상의 화질 변화를 평가하기 위해 연구 대상자 중 Chest CT & Enhancement를 촬영한 환자를 단순 무작위 표본 추출(Simple random sampling) 방법을 사용하여 정량적 평가를 위하여 각 군당 50명씩 총 150명의 환자를 선정하였으며, 정성적 평가를 위하여 각 군당 20명씩 총 60명의 환자를 선정하였다. 본 연구결과 에어 매트리스로 인하여 환자의 주관적 편안함이 증가하였으며, 임상영상의 정량적, 정성적 평가 결과 화질의 차이는 나타나지 않았다. 이상의 결과를 보았을 때 에어 매트리스는 진단 영상에 아무런 해가 없이 환자의 주관적인 편안함을 높일 수 있는 방법으로 유용하게 적용될 수 있을 것으로 사료된다.

• Korean Journal of Radiology
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• 제22권10호
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• pp.1719-1729
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• 2021

Objective: Emphysema and small-airway disease are the two major components of chronic obstructive pulmonary disease (COPD). We propose a novel method of quantitative computed tomography (CT) emphysema air-trapping composite (EAtC) mapping to assess each COPD component. We analyzed the potential use of this method for assessing lung function in patients with COPD. Materials and Methods: A total of 584 patients with COPD underwent inspiration and expiration CTs. Using pairwise analysis of inspiration and expiration CTs with non-rigid registration, EAtC mapping classified lung parenchyma into three areas: Normal, functional air trapping (fAT), and emphysema (Emph). We defined fAT as the area with a density change of less than 60 Hounsfield units (HU) between inspiration and expiration CTs among areas with a density less than -856 HU on inspiration CT. The volume fraction of each area was compared with clinical parameters and pulmonary function tests (PFTs). The results were compared with those of parametric response mapping (PRM) analysis. Results: The relative volumes of the EAtC classes differed according to the Global Initiative for Chronic Obstructive Lung Disease stages (p < 0.001). Each class showed moderate correlations with forced expiratory volume in 1 second (FEV₁) and FEV₁/forced vital capacity (FVC) (r = -0.659-0.674, p < 0.001). Both fAT and Emph were significant predictors of FEV₁ and FEV₁/FVC (R² = 0.352 and 0.488, respectively; p < 0.001). fAT was a significant predictor of mean forced expiratory flow between 25% and 75% and residual volume/total vital capacity (R² = 0.264 and 0.233, respectively; p < 0.001), while Emph and age were significant predictors of carbon monoxide diffusing capacity (R² = 0.303; p < 0.001). fAT showed better correlations with PFTs than with small-airway disease on PRM. Conclusion: The proposed quantitative CT EAtC mapping provides comprehensive lung functional information on each disease component of COPD, which may serve as an imaging biomarker of lung function.

• 한국방사선학회논문지
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• 제16권1호
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• pp.7-13
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• 2022

본 연구는 심전도 게이팅을 한 방법과 심전도 게이팅 없이 검사하는 방법으로 검사하여 대동맥 뿌리 영상을 비교하는 것이며 high pitch(flash) chest pain protocol 방법으로 검사한 영상들과 기존의 방식으로 심전도 게이팅 없이 검사한 환자의 대동맥 뿌리 영상의 질환 유무를 관찰하였다. High pitch(flash) chest pain protocol과 일반적인 chest pain protocol로 AAPM 팬텀을 스캔하였으며 이렇게 획득된 팬텀 영상을 가지고 동일한 영상 품질을 가지는 파라메타 값을 조절하고 방사선량, 즉 CTDI 값을 비교해 보았다. 심전도 게이팅을 함으로 해서 상행대동맥의 이미지 왜곡은 기존의 심전도 게이팅을 하지 않은 검사방법보다 월등하게 감소시킬 수 있었고 대동맥 뿌리의 영상 품질은 향상되었다. 영상 이미지 품질의 차이를 보이지 않는 파라메타 범위 내에서, high-pitch chest pain protocol로 검사하였을 때 CTDI 값이 더 낮게 나왔으므로 방사선량 감소에도 이점이 있음을 알 수 있었다. 심장과 관련된 분야에서 선량 감소 모드를 이용하여 대동맥 박리와 같은 진단 분야에 응용하여 적용한다면 획기적인 피폭선량 감소 효과뿐만 아니라 빠른 진단과 함께 신속한 치료가 필요한 환자들에게 매우 중요한 검사방법이 될 것으로 사료된다.

• 대한방사선치료학회지
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• 제17권2호
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• pp.147-153
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• 2005

목 적 : TBI의 자세 잡이 과정에서 실시하는 신체 계측과 보상체 제작 과정을 전산화 단층 모의치료기를 이용하고 그 유용성을 평가하고자 한다. 대상 및 방법 : 환자는 누운 자세를 취하고, 전산화 단층 모의치료기를 통해 영상을 얻었다. 이 영상을 Somavision으로 전송하고 영상을 통하여 신체 계측 점에 대해 계측을 하였다. 계측은 피부를 기준으로 계측을 하고, 폐에 대해서 영상을 이용하여 계측을 하였다. 영상으로 계측된 값을 통해 보상체 두께를 결정하였다. 또한 영상을 통한 보상체 위치를 결정하 고 확인하였다. 선량은 치료실에서 열형광소자를 이용하며 측정하였다. 결 과 : 신체 계측점에서 두께에 대하며 $1{\sim}2cm$의 일반 계측과 영상 계측의 차이를 보였다. 신체 길이는 일반 계측과 영상 계측이 $3{\sim}4cm$의 차이가 있었다. 또한, 영상을 통해 보상체의 밑그림을 그릴 수 있었다. 열형광소자를 이용한 선량 측정 결과 값은 머리, 목, 액와 ,가슴(폐 포함), 무릎 부위는 $92{\sim}98%$로 측정되었고 배, 골반, 서혜부, 발 부위는 $102{\sim}109%$로 측정되었다. 결 론 : TBI의 자세 잡이 과정에서 전산화 단층 모의치료기의 영상을 이용하는 것은 유용하였다. 신체 계측 점두께는 일반 계측과 영상계측의 차이가 적게 계측되었고, 길이에 대한 계측은 정확하게 이루어졌다. 영상을 이용한 계측은 신체 밀도까지 고려한 다양한 보상체 제작이 가능성을 보여주었다. 또한 보상체 위치 잡이를 정확하게 할 수 있고, 보상체의 모 양도 제한 받지 않고 쉽게 제작할 수 있다. 전체적인 치료실 자세 잡이 시간을 $15{\sim}20$분 단축할 수 있었고, 보상체 제작 시간은 약 15분 감소시켰다.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.133-137
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• 2008

폐흡충증은 폐흡충(Paragonimus westermani)의 중간 숙주인 민물 게, 민물 가재 등의 섭취를 통해 인체에 감염되는 기생충 질환으로, 기흉, 흉수, 낭성 종괴 등 다양한 임상 양상을 보인다. 고립 폐 결절로 형태로 발현하는 경우에는, 폐결핵 및 폐암 등과의 구분이 중요하다. 양전자 방출 단층촬영 검사가 감별 진단에 도움이 되지만, 폐결핵 및 폐 히스토플라스마종 등의 진균 감염에서의 위양성이 보고된 바 있다. 저자들은 48세 남자로 단순흉부촬영상 우연히 발견된 고립 폐 결절에 대한 평가 위해 내원한 환자에게서, 흉부 CT 및 FDG-PET에서 좌폐상엽의 폐문주위에 FDG 섭취가 증가된 고립 폐 결절 양상을 보여 폐암으로 의심하였으나, 폐엽 절제술을 시행 후 폐흡충증으로 진단하여 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제75권5호
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• pp.210-213
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• 2013

Superior vena cava syndrome (SVCS) is usually caused by extrinsic compression or invasion of the superior vena cava (SVC) by malignant tumors involving mediastinal structures. Although thymomas are well-known causes of SVCS, cases of SVCS caused by malignant thymomas protruding into adjacent vessels draining the SVC with thrombosis have been very rarely reported worldwide. We experienced a 39-year-old female patient with SVCS that developed after the direct invasion of the left brachiocephalic vein (LBCV) and SVC by an anterior mediastinal mass with a high maximum standardized uptake value on the chest computed tomography (CT) and positron emission tomography-CT. Based on these results, she underwent en bloc resection of the tumor, including removal of the involved vessels, and was eventually diagnosed as having a type B2 thymoma permeating into the LBCV and SVC. We present this case as a very rare form of SVCS caused by an invasive thymoma.

• Journal of Magnetics
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• 제21권2호
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• pp.293-297
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• 2016

For mastectomy patients, sufficient doses of radiation should be delivered to the surface of the chest wall to prevent recurrence. A bolus is used to increase the surface dose on the chest wall, whereby the surface dose is confirmed with the use of a virtual bolus during the computerized treatment-planning process. The purpose of this study is an examination of the difference between the dose of the computerized treatment plan and the dose that is measured on the bolus. Part of the left breast of an Anderson Rando phantom was removed, followed by the attainment of computed tomography (CT) images that were used as the basis for computerized treatment plans that were established with no bolus, a 3 mm-thick bolus, a 5 mm-thick bolus, and a 10 mm-thick bolus. For the computerized treatment plan, a prescribed dose regimen was dispensed daily and planning target volume (PTV) coverage was applied according to the RTOG 1304 guidelines. Using each of the established computerized treatment plans, chest-wall doses of 5 points were measured; this chest-wall dose was used as the standard for the analysis of this study, while the level of significance was set at P < 0.05. The measurement of the chest-wall dose with no bolus is 1.6 % to 10.3 % higher, and the differences of the minimum average and the maximum average of the five measurement points are -13.8 and -1.9, respectively (P < 0.05); however, when the bolus was used, the dosage was measured as 3.7 % to 9.2 % lower, and the differences of the minimum average and the maximum average are 7.4 and 9.0, -1.2 and 17.4, and 8.1 and 19.8 for 3 mm, 5 mm, and 10 mm, respectively (P < 0.05). As the thickness of the bolus is increased, the differences of the average surface dose are further increased. There are a variety of factors that affect the surface dose on the chest wall during post-mastectomy radiation therapy, for which verification is required; in particular, a consideration of the appropriate thickness and the number of uses when a bolus is used, and which has the greatest effect on the surface dose on the chest wall, is considered necessary.