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3 대한영상의학회지 2004;51: Table 1. Results of PEIT on and Gross Findings in 1 cm- and 5 cm-depth Groups Depth unit:mean±sd 1 ml 2 ml 3 ml 4 ml p-value 1 cm Width of necrosis (cm) Length of necrosis (cm) Area of necrosis (cm2) 1.80± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± cm Width of necrosis (cm) Length of necrosis (cm) Area of necrosis (cm2) 1.60± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± PEIT: Percutaneous ethanol injection therapy : ultrasonography A B C D Fig. 1. Ultrasonographic, gross and histologic findings after percutaneous ethanol injection therapy (PEIT) in bovid liver. A. Ultrasonography obtained immediately after 4ml ethanol injection shows irregular hyperechoic region. B. Gross s show irregular shaped whitish-discolorized necrosis which becomes gradually larger with increasing the amount of ethanol. C, D. Histopathologic s immediately after 4 ml ethanol injection show coagulation necrosis and sinusoidal dilatation (H & E, 40 (C), 100 (D)). 601
4 강봉주 외: 적출된 소 간에서 시행한 무수 에탄올 주입술, 극초단파 응고술 및 고주파 소작술의 조직괴사 효과의 차이에 관한 실험적 연구 게 측정되었는데 이것은 강한 에코와 동반된 음향음영으로 인 해 초음파 검사상 괴사 길이를 정확히 측정하기 어려움을 반 영하는 것으로 보인다(Table 4). 각 군의 최대치를 이용하여 비교한 결과는 Table 5에 요약 되어 있는데, 괴사 부위의 너비는 무수 에탄올 주입술군의 경 우 1.23±0.25 cm, 극초단파 응고술군의 경우 1.33±0.06 cm, 고주파 소작술군의 경우 2.37±0.15 cm로 고주파 소작술군에 서 가장 크고, 괴사 부위의 길이는 무수 에탄올 주입술군의 경 우 1.07±0.31 cm, 극초단파 응고술군의 경우 4.60±0.17 cm, 고주파 소작술군의 경우 3.83±0.29 cm로 극초단파 응고술군 에서 가장 길었다. 한편, π (width/2) (depth/2)의 타원의 면 적 공식을 이용하여 측정한 결과 전체 괴사 부위의 면적은 무 수 에탄올 주입술군의 경우 1.01±0.27 cm2, 극초단파 응고술 고주파 소작술군 극초단파 응고술군 실험과 마찬가지로 초음파 검사에서 가 장자리는 에코가 강하고 수증기와 가스에 인한 지저분한 음향 음영이 보여 응고 괴사되는 깊이를 정확히 측정하기 어려웠다 (Fig. 3A). 육안적 검사에서 난형의 미색의 괴사가 일어났으 며, 간 표면에서 1 cm 깊이에서 시술시 간피막의 괴사가 일 어났다(Fig. 3B). 조직 검사에서 동양혈관(sinusoid)의 확장 이 주된 소견이었고 전극침 주변으로 괴사, 그 주위로 유섬유 소(fibrinoid)와 낭성 변성, 그 주위로 동양혈관의 확장 등의 소견도 있었다(Fig. 3C, D). 고주파 조사시간이 길어짐에 따 라 초음파상 고에코 부위의 너비와 길이 및 면적이 증가하였 다(Table 3). 초음파상의 괴사 부위의 너비가 육안 소견보다 유의하게 크게 나타난 반면, 길이는 초음파상의 길이가 더 작 A B C D Fig. 2. Ultrasonographic, gross and histologic findings after percutaneous microwave coagulation therapy (PMCT) in bovid liver. A. Ultrasonography obtained immediately after PMCT(60W, 120 seconds) shows irregular hyperechoic region (indicated by cursors) with posterior acoustic shadowing. B. Gross s show elliptical-shaped areas of whitish discoloration and central brownish discoloration surrounding the course of the electrode tip. In the of 1 cm depth, liver capsule is also discolorized by necrosis (arrow). C, D. Histopathologic s immediately after PMCT show coagulation necrosis, sinusoidal dilatation, fibrinoid and cystic degeneration and hemorrhage around the electrode tip (H & E, 40 (C), 100 (D)). 602
5 대한영상의학회지 2004;51: Table 2. Results of PMCT on and Gross Findings in 1 cm- and 5 cm-depth Groups Depth 1 cm Width of necrosis(cm) Length of necrosis(cm) Area of necrosis(cm2) 5 cm Width of necrosis(cm) Length of necrosis(cm) Area of necrosis(cm2) unit:mean±sd 30 sec 60 sec 120 sec p-value 1.70± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± PMCT: Percutaneous microwave coagulation therapy : ultrasonography A B C D Fig. 3. Ultrasonographic, gross and histologic findings after radiofrequency (RF) ablation therapy in bovid liver. A. Ultrasonography obtained immediately after RF ablation therapy (12 minutes) shows hyperechoic region with posterior acoustic shadowing. B. Gross s show ovoid whitish discoloration and central brownish discoloration surrounding the electrode tip, indicating necrosis. These areas are wider than those of PMCT. In the of 1 cm depth, liver capsule is also discolorized by necrosis (arrow). C, D. Histopathologic s immediately after RF ablation therapy show coagulation necrosis, sinusoidal dilatation, fibrinoid and cystic degeneration (H & E, 40 (C), 100 (D)). 603
6 Table 3. Results of RF on and Gross Findings in 1 cm- and 5 cm-depth Groups Runit:mean SD Depth 6 min 8 min 10 min 12 min 14 min p-value 1 cm Width of necrosis (cm) Length of necrosis (cm) Area of necrosis (cm 2 ) cm Width of necrosis (cm) Length of necrosis (cm) Area of necrosis (cm 2 ) RF: Radiofrequency : ultrasonography Table 4. Comparison of Results from each procedure between and Gross Findings in 1 cm- and 5-cm Depth Groups unit:mean SD Modalities Depth Tissue necrosis p-value / PEIT 1 cm mean width of necrosis (cm) mean length of necrosis (cm) mean area of necrosis (cm 2 ) cm mean width of necrosis (cm) < mean length of necrosis (cm) mean area of necrosis (cm 2 ) < PMCT 1 cm mean width of necrosis (cm) mean length of necrosis (cm) < mean area of necrosis (cm 2 ) cm mean width of necrosis (cm) mean length of necrosis (cm) < mean area of necrosis (cm 2 ) RF 1 cm mean width of necrosis (cm) < mean length of necrosis (cm) mean area of necrosis (cm 2 ) cm mean width of necrosis (cm) < mean length of necrosis (cm) mean area of necrosis (cm 2 ) PEIT: Percutaneous ethanol injection therapy PMCT: Percutaneous microwave coagulation therapy RF: Radiofrequency : ultrasonography Table 5. Comparison of Shape and Maxima of Tissue Necrosis between PEIT, PMCT, and RF Groups unit:mean SD Results Maxima of tissue necrosis Mean width/length Shape Groups Width (cm) Length (cm) Area (cm 2 ) ratio of necrosis PEIT Irregular PMCT Elliptical RF Ovoid PEIT: Percutaneous ethanol injection therapy PMCT: Percutaneous microwave coagulation therapy RF: Radiofrequency : ultrasonography 604
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8 . 1999;41: ,,,,,. :. 2000;42: Livraghi T, Goldberg N, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210: D Agostino HB, Solinas A. Percutaneous ablation therapy for hepatocellular carcinoma. AJR Am J Roentgenol 1995;164: Hamazoe R, Hirooka Y, Ohtani S, Katoh T, Kaibara N. Intraoperative microwave tissue coagulation as treatment for patients with nonresectable hepatocellular carcinoma. Cancer 1995; 75: Sato M, Watanabe Y, Ueda S, Iseki S, Abe Y, Sato N, et al. Microwave coagulation therapy for hepatocellular carcinoma. Gastroenterology 1996;110: Seki T, Wakabayashi M, Nakagawa T, Itho T, Shiro T, Kunieda K, et al. Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 1994;74: McGahan JP, Browning PD, Brock JM, Tesluk H. Hepatic ablation using radiofrequncy electrocautery. Invest Radiol 1990;25: Patterson EJ, Scudamore CH, Owen DA, Nagy AG, Buczkowski AK. Radiofrequency ablation of porcine liver in vivo: effect of blood flow and treatment time on lesion size. Ann Surg 1998; 227: Rossi S, Buscarini E, Garbagnati F, Di Stasi M, Quaretti P, Rago M, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998;170: Hu HK. Microwave radiation treatment of liver cancer: animal experiment and preliminary clinical application. Chung Hua Wai Ko Tsa Chih 1989;27: McGahan JP, Brock JM, Tesluk H, Gu WZ, Schneider P, Browning PD. Hepatic ablation with use of radiofrequncy electrocautery in the animal model. J Vasc Interv Radiol 1992;3: Amin Z, Donald JJ, Masters A, Kant R, Steger AC, Bown SG, et al. Hepatic metastases: interstitial laser photocoagulation with realtime US monitoring and dynamic CT evaluation of treatment. Radiology 1993;187: Goldberg SN, Hahn P, Halpern EF, Fogle R, Gazelle GS. Radio-frequency tissue ablation: effect of pharmacologic modulation of 1.,,,,,. blood flow on coagulation diameter. Radiology 1998;209: :. 16. Goldberg SN, Gazelle GS, Solbiati L, Rittman W, Mueller PR. 1999;40: Radiofrequency tissue ablation; increased lesion diameter with a 2.,,,,,. perfusion electrode. Acad Radiol 1996;3:
9 Experimental Study for Comparison of the Ablation Effects of Extracted Bovid Liver by Percutaneous Procedures with Ethanol, Microwave, and Radiofrequency 1 Bong Joo Kang, M.D., Seong Tai Hahn, M.D. 1 Department of Diagnostic Radiology, College of Medicine, The Catholic University of Korea Purpose: The purpose of this study was to evaluate the differences in the ablation effects of percutaneous ethanol injection therapy (PEIT), percutaneous microwave coagulation therapy (PMCT), and radiofrequency (RF) ablation therapy in extracted bovid livers, and to assess the appropriate therapeutic method for treating hepatic tumors according to their shape, size and location. Materials and Methods: PEIT, PMCT and RF ablation were performed at 1 cm and 5 cm depth in bovid livers. PEIT was performed with 1, 2, 3 and 4 ml of ethanol, PMCT with 60 watt for a 30 th, 60 th and 120 th of a second, and RF ablation for 6, 8, 10, 12 and 14 minutes. Ultrasonography was used for the detection of the tissue necrosis that followed the different therapeutic modalities. Results: For PEIT, the extent of the necrosis was smaller than that of the other modalities. For PMCT, the necrosis was elliptical and longer in length. For RF, the necrosis was oval and larger in size. At 1 cm depth for PMCT and RF ablation, the liver capsule was injured. Conclusion: We concluded that these different findings in tissue necrosis would aid in selecting the appropriate therapeutic method for hepatic tumors according to the tumors shape, size and location. Index words : Liver, neoplasms Ethanol Microwaves Ultrasound (US) Address reprint requests to : Seong Tai Hahn, M.D., Department of Radiology, St. Mary s Hospital, The Catholic University of Korea. 62 Yeouido-dong Yongdungpo-gu, Seoul , Korea. Tel Fax lionmain@catholic.ac.kr 607
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A Study on Married Female Immigrants Life Style and Marriage Satisfaction in Terms of Preparing Their Old Age in Chungcheongnam-do Department of Gerontology, Hoseo University Doctoral Student : Hi Ran