대한방시선의학회지 1998;38: 경정맥간생검 : Quick-Core Biopsy Needle System 의유용성 1 정규식 안병권 2. 이상욱 3. 장희경 4. 오경숭 허진도 조영덕 목 적 : 경정맥간생검에있어 Quick-Core biopsy needl
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1 대한방시선의학회지 1998;38: 경정맥간생검 : Quick-Core Biopsy Needle System 의유용성 1 정규식 안병권 2. 이상욱 3. 장희경 4. 오경숭 허진도 조영덕 목 적 : 경정맥간생검에있어 Quick-Core biopsy needle system 의유용성을알아보고 자하였다. 대상및방법 : 1995년 12월부터 1997년 6월까지 Quick-Core biopsy needle system을사용하여경정맥간생겁을시행한 8명의환자를대상으로하였으며경피적간생검이상대적으로금기시되는혈액응고기전이상 4 명, 혈소판감소 3명, 복수 1명이였다. 내경정맥을통하여우간정맥까지 7F transjugular guiding catheter를넣고이 catheter내로 14G stiffening cannula를삽입한후이를통해 Quick-Core needle로간조직을천자하여핵심조직을채취하였다. 사용한검침의크기는 18G(n=3) 와 19G(n=5) 였다. 생검후채취된조직의크기, 적합성 (adequacy) 여부, 조직학적진단등을알아보았으며, 또한시술의합병증을알아보 았다. 결과 :8명모두성공적으로조직을얻을수있었다. 채취된조직의평균길이는 1.4cm ( cm) 이였으며, 이들은모두병리적진단을내리기에적합하였다.8예모두특이적인조직학적진단이가능하였으며이들은악성종양 2 예, 간경화 1 예, 전격성간염 1 예, 정맥폐색성질환 (venoocclusive disease) 2예, Banti 증후군 1 예, Budd-Chiari 증후군 1 예였다. 시술의합병증은천자부위의동통을호소한 1 명외에는없었다. 결 론 : 경정맥간생검에있어 Quick-Core biopsy needle system 은병리적진단에적합 한핵심조직을얻을수있어진단의정확도를향상시킬수있을뿐아니라안전한기구로생 각된다. 경피적간생검은간질환의조직학적진단에가장보편적으로 사용되고있는방법으로서이시술의임상적유용성은잘알려 져있다 (1). 그러나진행성간질환환자에서는혈액응고기전의 이상이나다량의복수가합병되는경우가많으며, 이경우출혈 의위험으로인해경피적생검은금기가된다 (2). 경정맥간생검은출혈성소인이높은환자에서경피적간생 검의대용으로사용되는간생검방법으로서그효과가인정되 어있다 (3-13). 그러나경정맥간생검에사용되는검침은대 부분 modified Ross transseptal needle 또는그변형으로서, 검체의크기가작고겸체의분절 (fragmentation) 이흔히일어 나진단의정확도가떨어지는단점이있다 (7, 6, 10-12). Gilmore 등 (1 4) 은내시경에서사용되는생검겸자 (biopsy for ce ps) 에 Vim -Silverman Trucut 생겸침을부착한새로운기구 를고안, 경정맥간생검에이용하여핵섬조직 (cor e l 고신대학교의과대학진단방사선과학교실 2 고신대학교의과대학일반외과학교실 { 고신대학교의과대학내과학교실 4 고신대학교의과대학병리학교실 tissue) 을 이논문은 \ 컨 10 월 l 일접수하여 년 11 월 1 9 일에채택되었음 얻음으로써진단의정확도를향상시킬수있었다고보고하였다 (15). 최근에는핵심조직을얻을수있는 Trucut 형식의새로운기구인 Quick-Core biopsy needle system( Cook, Bloomington, lnd) 이상품화되어경정맥간생검에이용되고있다. 저자들은경정맥간생검에있어새로운기구인 Quick-Core biopsy needle system의유용성을알아보고자하였다. 대상및방법대상 1995년 1 2월부터 19 97년 6월까지 Quick-Core biopsy needle system을사용하여경정맥간생검을시행한 8명의환자를대상으로하였다. 나이는평균 44세 (21-61세) 였고, 남녀비는 7:1이었다. 간생검은진행성간질환의원인과정도를알기위해 (n=4), 백혈병환자에서간침범유무를알기위해 (n= 2 ), 그리고악성종양의조직학적증명을위해 (n=2) 시행하였다. 경정맥간생검은경피적간생검의금기가되는혈액응고기전이상 (prothrombin time> 15 seconds), 혈소판감소 (plat e let
2 쟁정뮤식오 1: 경정맥간생검 count < 60,000/ cm 3 ), 그리고다량의복수가있을때시행하였 다 (1, 11). 4 예에서 prothrombin time 이 15 초이상 ( 평균 20.3 초 ) 연장되어있였고이중 1 예에서는혈소판감소와다량의복 수가동반되어있었으며, 3 예에서는혈소판이 60,000/ cm 3 이 하 ( 평균 31,000/ cm 3 ) 로감소되어있었다. 나머지 1 예는간우 엽을미만성으로침범한종괴로 prothrombin time 과혈소판 수치는정상이었으나소량의복수가동반되어있였으며출혈의 위험이높을것으로생각되어경정맥생검을하였다. 기 구 Quick-Core biopsy needle system 은길이 49cm 직경 7F 의 transjugular guiding catheter, 80cm 5F multipurpose curve catheter, 50.5cm 14gauge thin-walled stainless steel stiffening cannula, 그리고 Quick-Core biopsy needle 로구성 되어있다 (Fig. 1). Quick -Core biopsy needle 은일반적으로 핵심조직생검에사용되는자동화된생검총 (automated biopsy gun) 과원리가같무며용수철작용에의한발사장치가내장되 어있고, 먼저 20mm 의 specimen notch 를포함한 inner stylet 을조직내에전진시킨다음발사장치를누르면 cutting cannula 가 stylet 을따라전진하면서핵심조직을떼어내게된다. 사하였다.2명의환자에서시술후 48시간이내에복강내출혈유무를위해복부초음파검사를시행하였다. 결과 8명모두에서성공적으로조직을채취할수있였다. 채취된조직은전예에서포르말련에고정시킨후가장긴길이를측정하였으며평균길이는 1.4cm ( cm) 이였다 (Fig. 2). 1cm 이하의작은조직절편도있었으나이들은모두병리학적검사를위해준비하는과정에서분절이일어난것으로생각되며특히악성종양으로확진된 2예에서분절이더잘관찰되었다 (Fig. 3). 그러나이들모두병리적진단을내리기에적합하였다. 8예모두임상소견과종합하여특이적인조직학적진단이가능하였으며 (Table 1) 이들은간세포암 1 예, 선암 l 예, 간경변증 l예, 전격성간염 1 예, 정맥폐색성질환 (venoocclusive dis ease) 2예, Banti 증후군 1예, Budd-Chiari 증후군 l 예였다. 백혈병의간침범을의심한 2예에서조직소견상모두이상세포의침범없이정맥폐색성질환으로확진되어치료의방침을결정할수있었다. 진행성간질환으로생검을시행한 4예에서는 방 법 시술 30 분전진통제와안정제를투여한후, 먼저초음파로우 측내경정맥의혈전증유무를확인한다음내경정맥의위치를 표시하였다. 내경정맥을천자하여투시하에서 inch 유 도철사를하대정맥까지진행시킨다음천자부위를확장기로 넓혀 7F guiding catheter 를하대정맥에위치시켰다. 이 guiding catheter 를통해 5F multipurpose catheter 를삽업하여 우측간정맥을선택하여간정맥조영술을시행한후생검할위 치를결정하였다. 다시혈관조영용카테터와유도철사를따라 guiding catheter 를간정맥내에위치시킨후혈관조영용카테 터는제거하고유도철사를따라 guiding catheter 내로 stiffening cannula 를삽업한후유도철사는제거하였다. Quick-Core needle 을발사장치가작동되게한상태에서 stiffening cannula 내로삽입하여 guiding catheter 의끝에위치시킨다음 needle 을포함한 catheter 와 cannula 전체를전면을향하게반시계 방향으로회전시킨후 needle 만더전진시켜간정액을통해간 조직을천자하였다. 일반적으로천자위치는하대정맥입구에 서 2-3cm 거리의간정맥에서시행하였으며간조직내로 1cm 정도 needle을전진시켰다. 다음은 Quick-Core needle의 lllner stylet을간조직내에전진시킨후발사장치를눌러핵심조직을얻었다 (Fig. 2A, B). Guiding catheter와 stiffening cannula 는간정맥내에둔채 Quick -Core needle 을제거하여발사장치 를작동시켜 inner stylet 을전진시켜핵심조직이포항된 specimen notch 를노출시켜조직을포르말린에담근후같은 조작을 - 반복하였다. 전예에서환자당 2 개의핵심조직을채취하 였고, 사용한검침의크기는 18G(n=3) 와 19G(n=5) 였다. 생검후채취된조직의크기, 적합성 (adequacy) 여부, 그리 고조직학적진단등을알아보았으며, 또한시술의합병증을조 A B Fig. 1. A. Principal components of the Quick-Core biopsy needle system used for transjugular liver biopsy : transjugular guiding catheter (right), stainless steel stiffening cannula (middle) and Quick-Core biopsy needle (Ieft). B. An enlarged view of the Quick-Core biopsy needle shows open specimen notch in the inner stylet and outer cutting cannula.
3 싫대한빙시선의학호 지 1998;38: 모두조직소견상간세포파괴의정도, 섬유화유무와정도등을 확인할수있었다. 특히임상적으로간경변증을의심하였으나 바이러스표식자 (viral mar ker ) 와종양표식자 (tumor marker) 에서유의한소견을보이지않았던 2 예에서조직소견상 각각 Banti 증후군과 Budd-Chiari 증후군에적합한소견으로 확진되었다 (Fig. 2). 악성종양 2 예중 1 예는심한문맥혈전이 관찰되였고시술전임상적으로훼장암의문맥침범으로생각 하였으나조직소견상문맥내에위치한간세포암을확인할수 있였다 (Fig. 3). 시술의합병증은천자부위의통증을호소한 l 예외에는치 료를요하는심각한합병증은없었다. 초음파검사를시행한 2 예에서상복부에이상액체저류는관찰되지않았다. 간세포암 으로확진된환자에서시술 3 일후에사망하였으나시술과연 관된심한출혈의증거는없었으며임상적으로간신장증후군 (hepatorenal syndrome) 을사망원인으로추정하였으나부검 은시행하지않았다. 고 미만성간질환의조직학적진단을위해가장보편적으로사용 r 률숱 A 찰 B 되는방법은경피적홉인생검솔로서시술이간편용이하며심한 합병증이드물고사망률이 0.01% 이하의안전한시술로인정되 어있다 (1). 또한최근에는자동화된생검총을이용한핵심조직 생검법이도입되면서진단의정확도가더욱향상될뿐아니라합 병증의번도도감소되었다 (1 6). 그러나출혈의위험이높은환자 에서는경피적생검술은여러장점에도불구하고금기가된다. Sher lock ( 1) 은 prothrombin time 이정상치에비해 3 초이상 연장되어있거나, 혈소판수치가 60,000/ cm 3 야하로감소되어 있는경우출혈의위험이높으고로경피적간생검을하지않도록 권하였다. McGill 등 (2) 은 9,212 예의간생검을분석한결과고 령, 여성, 악성종양, 그리고천자회수가많은경우등에서출혈의 빈도가높았으며, 혈소판수치가 56,000 / cm 3 이하로감소되거 나 prothrombin time 이 16.7 초이상연장되어있는경우경피 적간생검의금기로생각하였다. 복수가있는경우일부에서는 경피적생검의절대적금기로생각하지않으나 (1 7), 일반적으 Fig year-old man with Banti syndrome confirmed by transjugular liver biopsy. A. Right hepatic venogram after selective catheterization by using Quick-Core biopsy system. The guiding catheter-stiffening cannula combination is in position in the right hepatic vein. B. The Quick-Core biopsy needle is advanced into the liver, and the specimen notch is exposed within the liver parenchyma. The needle was operated by depressing the firing pin, which caused the cutting cannula to advance over the inner stylet and to obtain a core tlssue. C. Biopsy specimens measuring about 1.8cm in maximum length D. Photomicrograph of the biopsy specimen shows fibrous thickening of the portal vein wall with extension into the sinusoidal area(blue color). (Masson-Trichrome, X 100) KosinM.C. S 혔 쫓 O l 2 3 cm C D m
4 정뮤석오 1: 경정맥간생김 A B C D Fig year-old man with hepatocellular carcinoma confirmed by transjugular liver biopsy. A. CT scan shows an extensive portal vein thrombosis. Dilatation of intrahepatic duct is also seen B. CT scan obtained 20 mm lower than A shows a soft tissue mass in periportal area as well as portal vein thrombosis. C. Biopsy specimens measuring about 1.0 cm in meximum length. D. Photomicrograph of the biopsy specimen shows tumor emboli of anaplastic hepatocytes with trabecular pattern within the vessellumen. (H & E, X 100) 로복수의양이많을경우경피적생검의상대적금기가된다. 이와같은경피적간생검의금기가되는경우경정액간생검의 적응증이된다. 저자들의경우경정맥간생검의적응증으로 Sherlock 의범주를따랐으며, 7 예에서혈소판수치가감소되어 있거나 prothrombin time 이연장되어있었다. 1 예에서는소량 의복수만있었으나악성종양이의섬되였으며출혈의위험이 높을것으로생각되어경정맥생검을하였다. 경정맥간생검은 1964 년 Dotter (l 8) 가동물실험에성공하 였고, 1967 년 Hanafee 등 (3) 에의해처음엄상에적용되면서 혈액응고기전이상이있거나다량의복수가있는환자, 즉경피 적간생검이금기가되는경우에널리이용되어왔으며, 적절한 검체를얻기위한방볍도보강, 개선되어왔다 ( 8, 14). 이시술 의성공률은 62% (1 9) 에서 97%(7, 15) 까지다양하게보고되어 있으나환자의수, 질병의종류, 시술방법, 병리적해석등에 따른차이가심하다. 최근 Corr 등 (1 2) 은 200 명의환자에서 modified Ross transeptal needle 로시술한결과 77% 의성공 률을보였으며나머지 23 % 에서대부분검체의심한분절로인 해병리적진단에부적합하였다고보고하였다. MaAfee 등 (1 1) 은역시같은기구를사용하여 92% 의성공률을보였으며 8% 에서검체가부적합하였다고보고하였으나검체가병리적진단 에적합한예는 69% 였고나머지 23% 는부족함 ( marginal ) 이 있었다. Lebrec 등 (7) 도 1033 명의환자중 97% 에서검체가병 리적진단에적합하였다고보고하였으나, 간경변증또는섬유 화를동반하는질환을가진환자에서분절이일어나지않은적 합한검체를얻을수있었던경우는 64 % 였다. 이와같이경정 맥간생검에서전통적인 Ross needle 의가장큰단점은검체의 심한분절에의한병리적판독의어려움이다. 이에반해 modified Trucut needle 을사용한 Bull 등 (1 5 ) 은 193 명의환자중
5 싫: H 한방사선의학호 지 1998 ; 38: rable 1. Patients Data 그 atient/ /S Patient HlStory <\ge/sex Ascites PT(s) PC(/cm3) Specimen Length Diagnosis Cx Others 1/s 8/M AML ; suspected ,000 l.4cm VOD No Hepatosplenomeg뽕 aly liver involvement 2/55 /M Rule out HCC , cm Adenocarcinoma, No CEA : 5000ng/ml metastatic CA 19-9: 10449ng/ml 3/37/F AJ.. L ; suspected , cm VOD Neck Hepatomegaly liver involvement pam 4/49/M Acoholic hepatitis, , cm Cirrhosis, No Varix, melena active splenomegaly 5/21/M Rule out cirrhosis , cm Budd-Chiari No Varix, syndrome HBs Ag/Ab( - / - ) 6/32/M Rule out cirrhosis, , cm Banti syndrome No Varix, splenomegaly, hematemesis HBs Ag/Ab( - /+) 7/41/M Progressive , cm Fulminant No HBs Ag/Ab( - /+) jaundice hepatitis HBc Ab( + ) 8/61/M Rule out pancreas , cm HCC No Expire due to cancer hepatorenal syndrome Note; PT(s)=prothrombin time (seconds), PC=platelet count, Cx=complication, AML=acute myelogenous leukemia, VOD=venoocclusive disease, HCC=hepatocellular carcinoma 97% 에서병리적진단에적합한조직을얻었다고보고하였다. 겸체의길이에있어서도 modified Ross n ee dl e이 cm 으로보고되었으나 ( 5, 11, 20), modified Trucut nee dle은 1. 8cm으로서 (1 5) Trucut 형의검침이크고분절이적은검체를얻을수있어진단의정확도를높일수있다. 가장최근에소개된 Quick-Core biopsy needle은자동화된 Trucut 형의검침으로서 Little 등 (21) 은이를사용하여 43명의환자에서 98% 의성공률을보였으며검체의길이도평균 1.5cm으로 100% 에서병리학적진단에적합하였다고보고하였다. 저자들의경우증례수는적어나검체의평균길이가 1.4cm 였으며전예에서특이적인조직학적진단을얻을수있어 Little 등의결과와일치하였다. Little 등은검체의평균길이가검침의크기 (18G, 1 9 G) 에따라차이를보인다고하였으나저자들의경우증례수가적어의미있는차이를찾을수없었다. 그러나악성종양 2예와 Budd-Chiari 증후군 1예에서검체의길이가상대적으로짧았으며, 분절이잘생긴다고알려진간경변증 1예에서는오히려검체의길이가걸었다. 검체의길이가짧은예는모두검침을재사용한경우로서검침을소독하는과정에서기구의용수철작용이나 cutting cannu l a의작동이약화되어조직의채취력이떨어진것으로생각된다. 그러나분절이일어난작은검체절편도병리적검사에적합하였으며따라서경정맥간생검에서도이러한 Trucut 형의절단작용에의한검체의채취가파손이적은적합한검체를얻을수있을것으로생각된다. 경정맥간생검의기술적인실패요인으로서경정맥천자나 m 간정맥의삽관이어려운경우가있다 (11). 특히혈액응고이상이있는환자에서경정맥천자시인접한경동맥이천자될경우혈종, 출혈등의합병증이유발될수있다 (7, 12). Teare 등 (23) 은생검겸자 (biopsy forcep s) 를이용하여대퇴정맥으로접근함으로써이러한합병증을방지할수있었다고보고하였다. 그러나초음파유도하에경정액천자흘시행할경우경정맥의해부학적위치, 경정맥혈전증유무등의유용한정보를얻을수있을뿐아니라경동맥천자의위험을방지할수있다 (22). 저자들의경우전예에서경정맥천자시초음파유도하에시행하였으며 l회또는 2회의천자로성공적으로경정맥삽관을할수가있였다. 말기간질환환자에서간이심하게위축되거나다량의복수가동반된경우에는우측간정맥과하대정맥사이에예각이이루어져전통적인 Ross transseptal needle을사용한경우간정맥의삽관이어려워시술을할수없는경우가있다 (5, 7, 11, 20). 그러나 Quick-Core biopsy system의 guiding catheter 와 biopsy need le은어느정도유연성을가지고있으며따라서간정맥과하대정맥사이의예각이심한경우에도간정맥삽관이용이하다 ( 2 1). 저자들의경우다량의복수가동반된환자와 Budd -Chiari 증후군환자에서무리없이시술을할수가있었다. 경정맥간생검의합병증은 20% 까지보고되고있으나 (11), 이들대부분은발열, 복통, 천자부위혈종등의경미한합병증이다. 이시술의가장심각한합병층은간피막의천자에의한복강내출혈로서그빈도는 6% 까지보고되어있으며 (1 2) 이로
6 정뮤식오 1: 경정맥간생검 인한사망률은 % 로보고되어있다 (7, 10, 15). 저자들 의경우천자부위의통증을호소한 1 예외에는심각한합병증은 관찰되지않았다. 간피막의천자는간정맥의말초부에서생검 을시행할경우잘발생한다 (1 0, 11). 따라서간정맥의중심부 에서생검을함으로써중증합병증을줄일수있을것으로생각 되며또한경정맥천자시초음파를이용하면이와관련된합병 증을감소시킬수있을것으로생각된다. 결론적으로경정맥간생검에있어 Quick-Core biopsy needle system 은병리적진단에적합한핵심조직 (core tissue) 을얻을수있어진단의정확도를향상시킬수있을뿐아니라 합병증의빈도를낮출수있는안전한기구로생각된다. 참고문헌 1. Sherlock S. Diseases of the liver and biliary system. 8th ed Oxford : Blackwell Scientific Publications, 1989: McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy Gastroenterology 1990; 99 : Hanafee W, Weiner M. Transjugular percutaneous cholangiography. Radiology 1967; 88: R sch J, Lakin Pc. Antonovic E, Dotter CT. Transjugular approach to liver biopsy and transhepatic cholangiography. N Engl J Med 1973; 289: R sch J, Antonovic E, Dotter CT. Transjugular approach to the liver, biliary system, and portal circulation. Am J Roentgen Rad Ther Nucl Med 1975; 125: Goldman ML, Gonzalez AC, Galambos JT, Gordon IJ, Oen K-T. The transjugular technique of hepatic venography and biopsy, cholangiography, and obliteration of esophageal varices. Radiology 1978; Lebrec D, Goldfarb G, Degott C, Rueff B, Behamou J-P. Transvenous liver biopsy : an experience bases on 1000 hepatic tissue samplings with this procedure. Gastroenterology 1982 ; 83 : Colapinto RF, Blendis LM. Liver biopsy through the transjugular approach: Modification of instruments. Radiology 1983 ; 148: Velt PM, Choy OG, Shimkin PM, Link Rj. Transjugular liver biopsy in high-risk patients with hepatic disease. Radiology 1984; 153 : Gamble P, Colapinto RF, Stronell RD, olman JC, Blendis LM. Transjugular liver biopsy: a review of 461 biopsies. Radiology 1985; 157 : McAfee JH, Keeffe EB, Lee RG, R sch J. Transjugular liver biopsy. Hepatology 1992 ; 15: Corr p, Beningfield SJ, Davey N. Transjugular liver biopsy: a review of 200 biopsies. Clin Radiol 1992; 45: Donaldson RW, Copinath R, W따lless IR, et al. The role of σansjugular liver biopsy in fulminant liver failure : relation to other prognostic indicators. Hepatology 1993; 16: Gilmore IT, Bradley RD, Thompson RPH. Improved method of transvenous liver biopsy. Br Med J 1978; 2 : Bull HJM, Gilmore IT, Bradley RD, Marig이 d JH, Thompson RPH. Experience with transjugular liver biopsy. Gut 1983; 24 : Bernadino ME. Automated biopsy devices: significance and safety. Radiology 1990; 176: Murphy FB, Barefield KP, Steinberg HV, Bernardino ME. CTor sonography-guided biopsy of the liver in the presence of ascites : frequency of complications. AJR 1988; 151 : Dotter CT. Catheter biopsy : experimental technique for transvenous liver biopsy. Radiology 1964; 82 : Gilmore IT, Bradley RD, Thompson RPH. Transjugular liver biopsy. Br Med J 1977; 2: Choy OG, Shimkin PM, Link RJ, Calabrese PR. The transjugular route as an alternative to direct percutaneous needle biopsy of the liver. Am J Gastroenterol 1978 ; 70 : Little AF, Zajko AB, Orons PD. Transjugular liver biopsy: a prospective study in 43 patients with the Quick-Core biopsy needle. J Vasc Interv Radiol 1996 ; 7: Soyer p, Lacheheb D, Levesque M. High resolution sonographic guidance for transjugular liver biopsy. Abdom Imaging 1993; 18 : Teare JP, Watkinson AF, Erb SR, et al. Transfemoral liver biopsy by forceps: a review of 104 consecutive procedures. Cardiovas Intervent Radiol 1994; 17:
7 [H 한밤시선의학회지 1998;38: J Korean Radi 이 Soc 1998; 38: Transjugular Liver Biopsy : The Efficacy of Quick-Core Biopsy Needle System 1 Gyoo Sik Jung, M.D., Byung Kwon Ahn, M.D. 2, Sang Ouk Lee, M.D. 3 Hee Kyong Chang, M.D. 4, Kyung Seung Oh, M.D. Jin Do Huh, M.D., Young Duk Joh, M.D. 1 Department of Radiology, Kosin Medical College, Pusan, Korea, 2Department of General Surgeη 3Department of Internal Medicine, 4Department of pathology Purpose: To evaluate the efficacy of the Quick-Core biopsy needle system in performing transjugular liver biopsy. Materials and Methods: Between December 1995 and June 1997, eight patients underwent transjugular liver biopsy involving use of the Quick-Core biopsy needle system; the conditions involved were coagulopathy (n=4), thrombocytopenia (n=3), and ascites (n=i). Via the right internal jugular vein, the right hepatic vein was selectively catheterized with a 7-F transjugular guiding catheter, and a 14-guage stiffening cannula was then inserted through this catheter; to obtain core tissue, a Quick-Core needle was then advanced into the liver parenchyma through the catheter-cannula combination. Eighteen- and 19-9uage needles were used in three and five patients, respectively; specimen size, adequacy of the biopsy specimen and histologic diagnosis were determined, and complications were recorded. Results: Biopsy was successful in al1 patients. The mean length of the specimen was 1.4cm (1.0 - L8cm), and al1 were adequate for pathologic examinations; specific diagnosis was determined in al1 patients. There were two malignant neoplasms, two cases of veno-occlusive disease, and one case each of cirrhosis, fulminant hepatitis, Banti syndrome and Budd-Chiari syndrome. One patient complained of neck pain after the procedure, but no serious procedural complications were noted. Conclusion : Our preliminary study shows that the Quick-Core biopsy needle system is safe and provides adequate core tissues with high diagnostic yields. Index words: Biopsies, technology Liver, biopsy Address reprint requests to : Gyoo Sik, Jung, M.D., Department of Radiology, Kosin Medical College, Pusan, Korea ~ 34, Amnam-Dong, Seo-Gu, Pusan, Korea. Tel Fax 때
8 1998 년도대한방사선의학회춘계학술대회안내 일시 : 1998 년 4 월 17 일 ( 금 ) - 18 일 ( 토 ) 장소 : 호탤롯데부산 : 부산광역시부산진구부전동 (!) Tel (82-51) Fax (82-51) 사무국 : 서울시서초구양재동 잉 (Tel (82-2) Fax (82-2) ) Home page : http: adiol.medikorea.net E - mail 평 접 :8 평점예정 ( 평점카드발급은학술대회장소에비치된등록서명지에서명한회원에한하여 학술대회종료후발급, 우편으로우송하여드립니다.) 사전등록마감 : 1998 년 2 월 28 일까지 등록비 : I 구분 사전등록마감 (1 998 년 2 월 28 일 ) I 현장등록 (1998 년 2 월 28 일이후 ) 정회원 70,000 원 80,000 원 전공의회원 30,000 원 비회원 70,000 원 학술대회초록집 : 학술대회이전에미리발송 40,000 원 80,000 원 사전등록신청 : 사전등록은등록비를평화은행구좌번호 : 예금주 : 대한방사선의학 회구좌로송금이완료된경우만언정하며, 송금한후학회 Home Page 를이용하여신청하 거나사전등록신청서를학회로송부하시면됩니다. 초록제출마감 : 1998 년 1 월 31 일 ( 토 ) 초록제출처 : 학회사무국 특 학술행사 강 : D. Vorwerk, M.D.(Technical University of Aachen, Germany - Intervention) 십포지움 1. 4 월 17 일 ( 금 ) 13: : 30(Room C) -Neointimal Hyperplasia in stents and stent 융 rafts II.4 월 18 일 ( 토 ) 08 : : 30(Room 통합 ) -Venous Interventions- 주제 : Common Pediatric Malignant Tumors in Children 진행 : 검보경 ( 성균관의대 ) 발표 : 윤춘식 ( 연세의대 ) Neuroblastoma 검우선 ( 서울의대 ) Lymphoma Technical Forum 주저 I : Functional Imaging(MR, PET) 이선화 ( 이화의대 ) Wilms tumor 검옥화 ( 아주의대 ) Rhabdomyosarcoma 증례퀴즈 :17 일 ( 금 ) 오전오후반나절에 3 case 썩모두 6 case 가전시되고채점후다득점자에게등 의료기기전시 록처에서상품이주어집니다. 방사선과에서사용되는의료장비, 기기및제약등의전시를통하여그현황과발전방 향에관한식견을넓히는기회로주어집니다. 전시기간 : 1998 년 4 월 17 일 ( 금 ) 08: 일 ( 토 ) 13 : 00 까지 전시장소 : Pearl room(3 층 ), Crystal ballroom foyer(3 층 ) 중요일정 초록제출마감 : 1998 년 1 월 31 일 ( 토 ) 초록접수통보 : 1998 년 2 월 10 일 ( 화 ) 사전등록신청마감 : 1998 년 2 월 28 일 ( 토 ) 초록발송 : 1998 년 3 월 25 일 ( 목 ) 특강연사원고마감 : 1998 년 l 월 31 일 ( 토 ) 의료기전시신청마감 :1998 년 2 월 16 일 ( 월 ). 초록채택통보 : 1998 년 3 월 10 일 ( 화 ) 사전등록취소가능일 :1998 년 3 월 31 일 ( 화 )
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