Earticle

목 적: 간과 간 내에 생긴 암이 위내의 크기, 위치변화에 따라 종양의 위치변화와 경향성을 평가하기 위함이다. 방법 및 고찰: 2009년 3월부터 2010년 4월까지 강남세브란스병원을 내원한 간 종양을 가진 환자 중 CT-simulation (컴퓨터 단층촬영을 이용한 모의치료)을 하기 전 2주 내에 컴퓨터단층촬영이나 양전자컴퓨터단층촬영영상을 가진 환자 9명을 대상으로 하였으며, CT-simulation는 6시간 공복을 유지하고, 영상융합을 위한 컴퓨터단층촬영이나 양전자컴퓨터단층촬영은 촬영직전에 240~260 cc 가량의 물을 섭취하도록 하였다. 두 종류의 영상은 RTP (Radiation Treatment Planning, Pinnacle 8.0 h)에서 각각 환자의 뼈 구조를 중심으로 영상융합을 하였다. 결 과: 물 섭취양은 240~260 cc로 일정하였으나 물 섭취 후 위장의 크기는 259.3 cc부터 495.4 cc로 다양하였으며, 두 가지 다른 상태에서 찍은 컴퓨터단층촬영들에서 나타난 위장의 부피변화는 개인의 차이는 있지만, 평균 130 cc 정도의 부피증가가 측정되었으며, 이는 평균 174%의 증가에 해당된다. 종합적인 종양 중심점의 절대거리는 0.52 cm에서 3.04 cm으로 평균 1.52 cm의 움직임을 보였으며, 머리-다리(Cranial-Caudal)방향으로는 0.1 cm에서 1.35 cm으로 평균 0.44 cm의 움직임을 보였고, 왼-오른(Left-Right)방향으로는 0.05 cm에서 2.75 cm으로 평균 1.22 cm의 움직임을 보였고, 배-등(Ventral-Dorsal)방향으로는 0.05 cm에서 1.85 cm으로 평균 0.33 cm의 움직임을 보였다. 결 론: 개인차가 커서 위장의 운동을 관찰하여 종양의 움직임을 예측하는 것은 힘들지만 위장이 채워짐에 따라, 복잡한 경로를 통해 간 종양의 위치가 오른쪽으로 치우치는 것이 관찰되었다. 이에 간종양 치료 시 치료 정확도를 확보하기 위하여 공복상태를 유도하는 것을 권장한다. 반면 공복상태가 어려울 경우 환자의 위장의 부피와 움직임을 측정하여 치료계획 시 간 종양의 움직임을 고려하여 방사선 치료를 할 것을 권장한다.

Purpose: It aims to evaluate the location change and tendency of hepatic and intrahepatic tumors according to gastric volume and change of location. Materials and Methods: It studied 9 patients with hepatic tumors who visited Gangnam Severance Hospital from March 2009 to April 2010 and who underwent CT or PET (Positron Emission Tomography) within 2 weeks before CT-simulation. The patients fasted for 6 hours before CT-simulation and drank 240~250 cc of water just before CT or PET for image fusion. Those two types of images were fused to RTP (Radiation Treatment Planning, Pinnacle 8.0h) focusing on bone structure of individual patients. Results: They drank 240~260 cc of water but their stomach volume after drinking water varied from 259.3 cc to 495.4 cc. Even though individual differences existed in the change of stomach volume before and after drinking water, the volume was increased by 130 cc (174%) on average. The change in absolute distance between the centers of tumors ranged from 0.52 cm to 3.04 cm (1.52 cm on average); from 0.1 cm to 1.35 cm (0.44 cm on average) in cranial-caudal direction; from 0.05 cm to 2.75 cm (1.22 cm on average) in left-right direction; and from 0.05 cm to 1.85 cm (0.33 cm on average) in ventral-dorsal direction. Conclusion: It is hard to predict the movement of tumors by observing stomach movement, due to great individual differences; however, it was observed that the location of hepatic tumors was right-sided as the stomach was filled with water. Thus, it is recommended to maintain the fastened state to secure the accuracy of hepatic tumor treatment. If it cannot maintain the fastened state, it is recommended to measure stomach volumes and movement in the patient to consider the movement of hepatic tumors before radiation treatment.

목적: 토끼에서 스펙트럼영역 빛간섭단층촬영(spectral domain optical coherence tomography, SD-OCT)을 이용하여 시신경유두(optic nerve head, ONH)로부터 거리에 따른 망막 각 층의 두께를 측정하고 이를 통해 망막 동물실험모델에서의 기본 자료를 얻고자 한다. 대상과 방법: 토끼 15마리의 우안에서 SD-OCT 영상을 얻은 후, ONH 테두리에서 시작하여 하방으로 1, 2, 3, 4 그리고 5 mm 위치에서 전체 망막층, 내망막층, 외망막층, 맥락막층, 신경절세포복합체층, 신경절세포층, 내핵층, 그리고 외핵층의 두께를 얻었으며, 측정 위치에 따른 각 층의 두께를 비교하였다. 결과: 총 망막두께(Pearson’s correlation coefficient [CC]=-0.778, p<0.05), 내망막층 두께(CC=-0.710, p<0.05), 외망막층 두께(CC=-0.495, p<0.05), 신경절세포복합체 두께(CC=-0.292, p<0.05), 신경절세포층 두께(CC=-0.284, p<0.05), 그리고 외핵층 두께(CC=-0.760, p<0.05)는 ONH에서 아래로 멀어질수록 감소하였다. 내핵층 두께도 ONH에서의 거리와 음의 상관관계를 보였으나 상관계수는 낮았다(CC=-0.263, p<0.05). 맥락막두께는 ONH에서 멀어질수록 증가하였다(CC=0.511, p<0.05). 결론: SD-OCT를 이용하여 ONH로부터 거리에 따른 토끼 망막두께를 분석하였다. 이 토끼 안저를 이해하는 데 도움이 될 것이며, 토끼 실험의 표준 자료로 사용할 수 있을 것이다.

Purpose: We used spectral domain optical coherence tomography (SD-OCT) to assess the retinal and choroidal thicknesses of the rabbit, a commonly used animal model of ophthalmic disease. We report normative datasets. Methods: Semi-automated measurements were made on 15 normal right eyes of New Zealand white rabbits. Total retinal, inner retinal layer, outer retinal layer, choroidal, ganglion cell layer, ganglion cell complex, inner nuclear layer, and outer nuclear layer thicknesses were measured at fixed distances (0, 1, 2, 3, 4, and 5 mm) below the optic nerve head. Results: Total retinal layer (Pearson’s correlation coefficient [CC] = -0.778, p < 0.05), inner retinal layer (CC = -0.710, p < 0.05), outer retinal layer (CC = -0.495, p < 0.05), ganglion cell complex (CC = -0.292, p < 0.05), ganglion cell layer (CC = -0.284, p < 0.05), and outer nuclear layer thicknesses (CC = -0.760, p < 0.05) decreased with the distance from the optic nerve head. Inner nuclear layer thickness correlated negatively with the distance from the optic nerve head, but the correlation coefficient was low (CC = -0.263, p < 0.05). Choroidal thickness increased with the distance from the optic nerve head (CC = 0.511, p < 0.05). Conclusions: Rabbit retinal thicknesses were measured and analyzed by the distance from the optic nerve head. The datasets will serve as standards when using rabbits.

PET/MRI에서는 MRI의 진단적 가치를 높이기 위해 T1 조영제를 사용하고 있다. PET의 감쇠 보정을 위해 T1 시컨스 계열인 VIBE DIXON은 조영제에 직접적으로 영향을 미치지만, 실제 ${\mu}-map$과 감쇠 보정된 PET 영상에는 큰 변화가 없었다. 그러므로 PET/MRI 검사시 조영제 사용은 PET 데이터 얻기 전 후 언제든 사용할 수 있을 것이다.

Purpose: Integrated PET/MRI has been developed recently has become a lot of help to the point oncologic, neological, cardiological nuclear medicine. By using this PET/MRI, a ${\mu}-map$ is created some special MRI sequence which may be divided parts of the body for attenuation correction. However, because an MRI contrast agent is necessary in order to obtain an more MRI information, we will evaluate to see an effect of SUV on PET image that corrected attenuation by MRI with contrast agent. Materials and Methods: As PET/MRI machine, Biograph mMR (Siemens, Germany) was used. For phantom test, 1mCi $^{18}F-FDG$ was injected in cylinderical uniformity phantom, and then acquire PET data about 10 minutes with VIBE-DIXON, UTE MRI sequence image for attenuation correction. T1 weighted contrast media, 4 cc DOTAREM (GUERBET, FRANCE) was injected in a same phatnom, and then PET data, MRI data were acquired by same methodes. Using this PET, non-contrast MRI and contrast MRI, it was reconstructed attenuation correction PET image, in which we evanuated the difference of SUVs. Additionally, for let a high desity of contrast media, 500 cc 2 plastic bottles were used. We injected $^{18}F-FDG$ with 5 cc DOTAREM in first bottle. At second bottle, only $^{18}F-FDG$ was injected. and then we evaluated a SUVs reconstructed by same methods. For clinical patient study, rectal caner-pancreas cancer patients were selected. we evaluated SUVs of PET image corrected attenuastion by contrast weighted MRI and non-contrast MRI. Results: For a phantom study, although VIBE DIXON MRI signal with contrast media is 433% higher than non-contrast media MRI, the signals intensity of ${\mu}-map$, attenuation corrected PET are same together. In case of high contrast media density, image distortion is appeared on ${\mu}-map$ and PET images. For clinical a patient study, VIBE DIXON MRI signal on lesion portion is increased in 495% by using DOTAREM. But there are no significant differences at ${\mu}-map$, non AC PET, AC-PET image whether using contrast media or not. In case of whole body PET/MRI study, %diff between contras and non contrast MRAC at lung, liver, renal cortex, femoral head, myocardium, bladder, muscle are -4.32%, -2.48%, -8.05%, -3.14%, 2.30%, 1.53%, 6.49% at each other. Conclusion: In integrated PET/MRI, a segmentation ${\mu}-map$ method is used for correcting attenuation of PET signal. although MRI signal for attenuation correciton change by using contrast media, ${\mu}-map$ will not change, and then MRAC PET signal will not change too. Therefore, MRI contrast media dose not affect for attenuation correction PET. As well, not only When we make a flow of PET/MRI protocol, order of PET and MRI sequence dose not matter, but It's possible to compare PET images before and after contrast agent injection.