大韓放射線톨훌學슐誌第 2 卷第 4 월 fl pp. 639-649, 985 Journal of Korean Radiological Society, Vo.2, No.4, 985 황달의감별진단에있어서의간담도走효의意義 순천향대학의학부방사선과학교실 金重均 孫昭葉 裵光洙 鄭훌燦 崔得廣 金基廷 - Abstract - The Analysis of Cholescintigraphy in Differentiating the Causes of J aundice Jung Gyun Kim, M.D., 50 Yeob 50n, M.D., Kwang 5u Bae, M.D., Moo Chan Chung, M.D., Deuk Lin Choi, M.D., Ki Jung Kim, M.D. Oepartment of Radiologκ College of ιedicine, Soonchunhyang University As a adjuvant, 99mTc-IDA complex cholescintigraphy has been used to differentiate the causes of jaundice, hepatocellular jaundice from the obstructive jaundice. 50 we conducted the retrospective study from the 4 cases of cholescintigraphy from the Mar. 83 to 5ept. 84 at the dept. of radiology in the 500nchunhyang university to determine the etiology and diffential points in the diagnosing the Jaundice. The following results were obtained;. As a st-ordered parameter, the leading edge hepatic parenchymal transit time was very significant in differentiating the causes of jaundice, among the hepatocellular jaundice, obstructive jaundice due to tumor, and obstructive jaundice due to cholelithiasis. (P<O.0 by X2-test) 2. As a 2nd-ordered parameter, hepatic clearance was very significant in differentiating the hepatocellular jaundice from the jaundice due to partial biliary obstruction (P<O.0 by t-test) 3. The difference in hepatic clearance between the biliary obstruction due to tumor and that of the cholelithiasis, was not significant. (P>O.05 by X2.tes 이 4. The difference in bile duct dilatation among the hepatocellular jaundice obstructive jaundice due to tumor, and obstructive jaundice due to cholelithiasis, was significant in differentiating the causes of jaundice. (P<O.05 by X2-test) 5 Intrahepatic stone showed. sciniigraphic intrahepatic pooling with partial stasis. 6. Cholescintigraphy was useful to differentiated the Rotor's syndrome from the Dubin-Johnson syndrome, supplying the additional criteria. 이논문은 985 년 7 월 5 일에접수하여 985 년 8 월 일에채택되었음. - 639-
- 大합放射線醫學! 誌 : 었 2 卷第 4 號 985 - 과시간 ( eading edge hepati c parenchyma I trans it 서 황달의강별진단은높은정확도를보이는초음파, 2 가선별검사로이용되고있고그외복부컴퓨터단 층촬영, 간담도走훌, 경피경간담도조영술, 내시경 적역행성웨담도초영슬, 경구담낭조영술, 경정맥 담도조영술, 간생검등이감별진단에이용되고있 다. 특히간담도走좁는 975 년 Harvey, Loberg 등 3,.> 에의하여 9.mTc - DA 계복합체가개발사용된 이래, 그사용이보편화되었고, 또한감별진단에도움 을주어왔다. 이에저자들은간담도走흉소견을분석하여황달의 감별진단에도움이되는지표를얻고자하였 며, 동시 에 Rotor 증후군 3 예의간담도走좁소견도기술코 저하였다. 론 대상및방법 983 년 3 월부터 984 년 9 월까지간담도走호를실 시하였던예중수술및임상검사로확진된 4 예를대 상으로하였으며, 群 종양또는담석으로인한담도폐쇄 24 예는원발성간세포장애가있는예를제외하 였다 (Table ). 방법은 99m Tc -HIDA 또는 DISIDA 5~0mCi 를정맥주사후 E lscint 社제품 (Elscint 40 w) 인감마카메라를사용하여 5, 0, 5, 30, 60 분 전연또는우측연상을얻었 며, 80 ml 의전유 (whole milke) 투여후 90 분! 앓담도또는장관방사능의 출현의지연時는 24 시간지연像을얻었다, 분석은첫 째간여과율 (hepatic clearance), 둘째간실질통 time), 세째담도構造, 네째담도조영유무를분석하였다. 간실질통과시간은정맥주사時로부터큰담도 (Iarger bile ducts) 또는陽管放射能의出現時까지로定義하였 며 S, 6,7), 간여과율은간담도走효像의 5 분前面像에서간섭취정도와심장및배후방사능의섭취정도를비교분석하겼으며, 그정도는 KIingeusmith 등과같이 5 등급으로분류하였다 (Table 2 ). 간담도構造는당도의확장유무및지속적인정체유무를분석하였다. 담낭조영분석은, 3 예의 Rotor 증후군에서그조영시간을기록하였다. 또한간내담석의간담도走흉소견도 Ye h 등 8) 의분석항목을인용분석하였다. Table 2. The Grade of Hepatic Clearance Hepatic clearance: analysis of anterior image at 5 min. Grade 0: images without apparent cardiac radioactivity Grade : those with minimal cardiac radioactivity Grade 2: those with equal cardiac and hepatic intensjty Grade 3: those with greater cardiac than hepatic intensity Grade 4: those showing no hepatic radioactivity relative to the surrounding background 성 적 종 $ 벼l 의한담도폐쇄환자群 예중 0 예 (90.9 % ) 에서장관방사능을보이지않았다. 이중 8 예에 Hepatobiliary Diseases Table. Materials Biliary obstruction secondary to primary and metastatic tumors Biliaηr obstruction secondary to cholelithiasis Hepatocellular dysfuction Rotor s syndrome Total No. of cases 3 4 3 4 서는평균 6.3 시간의지연像밖에얻지아니하였 나, 24 시간까지陽管能이出現하지않은것 ~ 로간주하여, 완전담도폐쇄로간주하였다. 또한간여과율은 6 예 (54.5% ) 에서제 2 등급이상의간여과융의저하를볼수있었으며 4 시간에담도가조영된 예에서는제 등급의경미한간여파율의저하을관찰할수있었다 (Ta ble3. Fig.). 담석에의한담도폐쇄群에서는 3 예중 6 예 (46. 2 % ) 에서완전담도폐쇄를보였다. 이중 3 예에있어서는 24 시간까지지연상을얻지않았다간여과율은 3 예 (23. %) 에서제 2 등급이상의중등도또는심한 - 640-
- 金重均外 황딸의감별진단에있어서의간담도 Æ 짚의 ;fi; 꿇 간여과율의저하가관찰되었고, 담도가조영된 7 예에 서는모두제 O~l 응급의정상 또는경미한간여과 율의저하를보였다 (Table4). 또한담석에의한담도폐쇄 3 예중간내담석 5 예 (38.5 % ) 를관찰할수있었으며, 이들의간 덤도 走훌소견은간내담도의지속적인방사능축적과부분 담도폐쇄그러고 2 예에 있어서는간좌엽의국소적인 光子결핍을 5 분前面 쟁에서관찰할수있었다 (Fig. 2.Fig.3). 그러나 2 예의 간내담석의경우담도가조 영되지않았다 (Table4). 간세포장애群에서는 4 예중 8 예 (57.%) 에서제 2 응급이상의간껴과융의저하를관찰할수있었으며, 陽管能을보이지않았던 예는간병변에이은간성흔수환자였고 7 시간지연像에서陽管能의出現 을볼수없었다. 냐머지 3 예에있어서는 6 예에서정상그리고 7 예에서는경미한간질질통과시간의지연을보였고상기 3 예모두당도의확장이관찰되지않았다 (Table 5). 이상의결과를險定호써l 있어, 부분담도폐쇄환자群 8 예 종양 예, 담석 7 예 ) 와陽管能의出現을보 - 3(V삐삐. 45/ 찌 IN. Initial Scan FoUow up scan after 7 months Fig.. 63-year-old man with complete biliary obstruction due to CBD Ca. Follow up examination of cholescintigraphy with the intervals of 7 months: marked decrease in hepatic clearance from grade to grade IV at 5 min. image, and complete obstruction. Marked decrease in hepatic cleance indicates the secondaη hepatocellular damage due to complete biliary obstruction. - 64-
- 大짧放 M 級뽑學會誌 第 2 卷第 4 號 985 였던간세포성황달群 3 예間의府여과율의 차이는 통계학적으호유의하였다 (p(0.05. X 2 險定, Table 6,Fig. Table 3. Hepatobiliary lmaging in Biliary Obstruction Diagnosis, Case No secondary to primary and Metastatic Tumors. C.B.D. Ca. with GB stone 2. Periampullary Ca. 3. Pancreas Ca. 4. C.H.D. Ca. 5. C.B.D. Ca. 6. C.B. D. Ca. 7. Stomach Ca. with mets. 8. C.B.D. Ca. 9. Periampullary Ca. 0. Colon Ca. with mets.. C. H.D. Ca. with stone Clearance lmaging Findings 4 3 2 4 4 nιnιi A A% Transit time (hr) >4 >4.5 >5 >6 >6 >7 >7 >7 >7.5 >24 > Ducts dilated 2). 그러나폐쇄성황달의감별진단에있어서 종양과 담석에의한담도폐쇄群間의府여과율의 차이는통 계학적인유의성을찾을수없었다 ( p>0.05. X 2 - 險定, Table 7 ). 종 $ 벼l 의한담도펴 l 쇄, 당석에의한담도폐쇄, 간 세포장애세群間의府실질통과시간의차이는통 계학적으로매우유의하였다 (p(0.0, X2 - 險 fie. Tables) 상기종 % 에의한담도폐쇄, 담석에의한담도폐쇄, 간세포장애세群간의담도확장유무의차이는통 계학적으로유의하였다 (p(0.05, X 2 - 險定, Table9). 3 예의 Rotor 증후군에서는모두 아동기로부터의 조기발병의황달을보였고 2 예에서는어머니와 남동 생그리고오빠와여동생에동일한황달의가족력을관 찰할수있었다. 이들의황달은 모두직접 황달혈증 (direct hyperbilirubinemia) 를보였 며정상의간 기능검사소견, 정상의간염바이러스지표, 정상의간조 직 소견 ( 간세포내의반점관찰할수없응 ) 을보였다. 99ffiTc_ DI SIDA 를이용한간담도走훌소견은모두제 3 등급의간여과율의저하, 강한배후방사능, 그리고 30 분 ~3 시간으로지연된간실질통과시간을보였다. 동시에 3 예모두담냥의조영을관찰할수있었다 I Table 4. Hepatobiliary Imaging in Biliary Obstruction secondary to Cholelithiasis lmaging Findings Diagnosis, Clearance Transit Ducts Case No. time (hr). GB stone with chronic cholecystitis 2. GB and CBD stone with chronic cholecystitis 3. GB stone 4. Remained CBD and intrahepatic stone 5. GB, CBD, and intrapheptic duct stone 6. GB and CBD stone 7. CBD and intrahepatic duct stone 8. G~ and CBD stone 9. GB and CBD stone 0. GB, CBD and intrahepatic duct stone. Remained CBD stone 2. CBD stone 3. ÇBD and Lt. intrahepatic duct stone l SOL in left lobe 0 SOL in left lobe 3 2 nu i qu 4 min. 5 min 30 min 30 min 30 min. 45 min 4 hours. > 4 hours > 5 hours. >7.5 hours >24 hours. >24 hours >24 hours. dilated dilated dilatedt dilatedt dilated dilatedt dilated t Scintigraphic intrahepatic pooling from 0 hours to 7 hours - 642 -
- 金重 i 칭外황달의강별진단에있어서의간당도 종의효짧 예에서시행한경구담낭조영술에서는정상의담냥조 Wistow 등, Klingensmith 등에의하여 3 - rose 영을보였다 (Table 0, Fig.4). 된 3 고 955 년 Taplin 등 9> 에의하여처음으로개발사용 - rose bengal 간담도走좁는 Taplin 등이간 여과, 간실질통과시간, 담도로의배설등의연속적 인평가가가능함을이해하였음도불구하고 3 의 선과고에너지의 찰 r 션으로인하여그사용워제한이있 었고임상응용에도논의의여지가있었다 0) 975 년 Hanvey, Loberg 등 3,4) 에의하여개말사용 B bengal 그리고 99mTc- pyridoxylidene glutamate (PG) 보다우수함이증명되었다. 또한 Reichelt 등 은황달의감별진단에있어 전담도폐쇄, 불완전또는부분담도폐쇄, 간세포성 황달로나누었을때그각각의진단적예민도 ( sensiitivity), 즉잔양성율 98~00 %, 74~78%, 77 ~ 90 % 라고보고하였다 5. 초음파검사는황달환자에서담도의상태를진단적 예민도 85~00 %, 득이도 75~ lo O %, 정확도 90~ 00 % 로반영하며, 당도폐쇄의위치와원인을구분 하는능력 48~87 % 를보인다고보고하였으며, 2) 또 완 된 99m Tc- IDA 계 복합체를이용한간담도走흉는 한초음파검사는담즙소치에의하여전혀영향을받 :)/' '. ::;'/MN 흡셋 & 3!VMIN 45/ MIN 30/MIN. 45/MIN... 홈 홈 A B Fig. 2. The difference in cholescintigraphic finding between hepatocellular jaundice and partial biliary 0 bstruction A: 26-year-old female patient with Banti syndrome. Moderate to severe decrease in hepatic cearance and normal parenchymal transjt tlme. B: 56-year-old man with partial biliary obstruction due to multiple intrahepaticand extrahepatic-bile duct stone. Well preserved hepatic cearance and delayed transit time till 4 hours with bile duct dilatation. Localized photon defect in left lobe of liver and scintigraphic intrahapatic pooling indicates the intrahepatic lithiasis. - 643-60/MIN. 톨 FAT MEAL. 90/4IH 警 $ 틀 -.:; HRS. 7 HRS. 췄홉 B
- 大합放射線훨學會웅 t 第 2 행第 4 號 985 - 지않으므로황달즘환자와담도장관문합술을시행하 되지않을경우 지흰지에있어서첫번째검사방법이되어야 한다고 네째담즙혈류역학을알고자할경우로그적응증을 주장하였다 Il. Rosenthall 은 ) 황달의강별 진단에 열거하였다. 또한 Rosenthall, Pauwels 등, 6, > 은 있어서초음파검사를첫째 선별검사로 간담도 走훌 간실질시간에의한황달의감별외에간여과율을감 를보초적인검사법으로주장하였고그적응응으로다 별지표로이야기하였고잔여과율은같은 담즙소치를 음파같은사항을지적하였다. 보인폐쇄성황달과간세포성황달群에있어 폐쇄성 첫째보조적도움이필요한경우 황달群에서의간여과율이세포성황달의그것보다높 둘째초음파검사가기술적으로어려운경우및불확 다고보고하였으며, 이를적용하연부분 담도폐쇄의 싣한결과로진단이어려운경우 진단적예민도를올릴수있다고주장하였다. 세째초음파검사가임상적또는간기능검사와부합 그러나간내황달 (I ntrahep ati c cholestasis) 은지 ;:)rl lln. l;:)/ I'I!N. 4;:)/M. RT.LAT. 60/IIN. 織隱 3Ø/ M It~ ~5 /MIN. 빼 IIJ 했삐 * FAT 4EAV. 90M 3 HRS. 톨., 헬활 ι 흩 톰.., Fig. 3. 42-year-old female patient with partial abiliary obstruction due to G.B. and, intrahepatic-and extrahepatic-bile duct stones Well preserved hepatic clearance (grade I) and delayed transit time and bile duct dilatation with persistent intrahepatic 뻐 d common duct pooling'of radioactivity until 3 hours. On ERCP, multiple small G.B. and, intrahepatic-and extrahepatic-bile duct stones are seen. 644 -
金!lí: i 낀外 : 황달의강별진단에있어서의간당도 Æ 아의 ;\!: 월 - Table 5. Hepatobiliary Imaging in Hepatocellular Dysfunction Diagnosis, Case No Clearance Imaging Findings Transit tlme Ducts 연된간실질통과시간을보이며이와는대조적무로정상또는경미한간여괴율의저하를보일경우폐쇄성황달로오진할수있다고하였다,6,7) 또한 Kling e nsmith 등, 김등, 서등, 김등 5,6, 8,9,20) 은간여과율의심한저하와이에동반한심한간실질통과. Traumatic hepatic rupture 2 0 min 시간의지연 A로인한 24 시간내에陽管能을발견하지못할경우심한간세포장이 } 와완전담도폐쇄그리고 2. Traumatic hepatic rupture 3. Hepatoma 4. Hepatitis 5. Banti Syndrome 6. Liver cirrhosis 7. Miliary tbc. 8. Chronic hepatitis with GB stone i qj nιi nι5 min 5 min 5 min. 5 min. 5 min 30 min 30 min. 이로인한간셰포장애를구분할수없다고하였고이 의강별을위해초음파검사, 컴퓨터단층촬영, 경피 경간담도조영술, 역행성웨 담도조영술등이 필요하 다고주장하였다. 또한 Klingensmith 등 S 은간외담도폐쇠 } 의 감탤 진단에있어간담도走좁소견으로종양에의한담도 폐쇄는일반적으로완전담도폐쇄와심한 간 여과율 의저하가이차적으로관찰되며, 담석에의한담도폐 9. Chronic hepatitis with GB stone 0. Acute viral hepatitis. Hepatoma 2. Acute viral hepatitis 3. Liver Cirrhosis with hepatic coma 2 l4 avι2 A 45 min 60 min. 90 min. 90 min. 4 hrs. 쇄는일받적 로부분담도폐쇄와정상또는 경미한 간여과율의저하를보고하였다 그러나 저자들의 예의종양에의한담도폐쇄群과 3 예의담석에의한 담도폐쇄群間의 8주 여과율의차이는통져 l 학적인유 의성을찾을수없었고 (T a ble 7) 이는김 등 20' 의 결 과와동일하였다 (p )0.05, X 2 - 險定 ). 4. Liver cirrhosis with hepatic coma 3 >7 hrs. 그러냐부분담도 8 예와간세포장애 3 예에서간여 5/MIN. 3 뱃 S. - 6HR 욱!'mi'.'i<'.,;",._ Fig. 4. 23-year-old female patient with Rotor s syndrome. On 5 min. Îmage, marked decrease in hepatic clearance as grade III and intense background up take in heart and kidney. Slight delay in hepatic parenchymal transit time, as 3 hours is seen. On oral cholecystogram, wel visualized gall bladder is seen without any abnormality - 645
- 大함放 g tf~~' 형會픔 - 第 2 卷第 4 bx 985 Table 6. The Differencc in Hepatic Clearance between Hepatocellular Jaundice and Partial Obstructive Jaundice Etiology Hepatic clearance Normal to mild decrease (Grade 0 - Grade ) Moderate to severe (Grade II - Grade IV) Overall Partial obstructive jaundice 8 0 8 Hepatocellular jaundice 6 7 3 Overall 4 7 2 The difference in hepatic clearance between above 2 group was significant by x 2 -test (P<0.05) Table 7. The Difference in Hepatic Clearance between 3 Groups at 5 min. Images Etiology Hepatic clearance Normal to mild Moderate to severe decrease decrease Overall (Grade 0 - Grade ) (Grade II - Grade IV) Cancer 5 6 Cholelithiasis 0 3 3 Hepatocellular jaundice 6 8 4 Overall 2 9 38 This difference in hepatic clearance between 3 groups was not significant by chi-sequare test. (P>0.05) Table 8. The Difference in Visualization of Intestine by 24 hrs. between 3 Groups. Table 9. The Difference in Dilatation of Bile ducts between 3 groups Etiology Visualization of intestine + Overall Cancer 0 Cholelithiasis 7 6.3 Hepatocellular jaundice 3 4 Overall 2 7 38 The patient not imaged through 24 hrs_ and not showed intestinal uptake, include complete obstruction. The difference in intestinal uptake by 24 hrs. between 3 groups washighly significant by chi-square test.(p<o.ol) 괴율의차이는통게학적으로매우유의성을보였다 (Table 6). 또한간내당석증은지속적인간내방사능축적, 부 Etiology Dilatation of Bile ducts Overall + Cancer 2 9 n Cholelithiasis 7 6 3 Hepatocellular jaundice 0 4 4 Overall 8 30 38 The difference in dilatation of bile ducts between 3 groups was significant by chi-square test. (P<0.05) 8,22> 의결과와동일하였다. 또한 2 예의간내당석증 에있어서는 5 분전면상에서는국소적인光子결핍을 볼수있었다 Rotor 증후군는 Dubin - J ohnson 증후군과함께만 성비용혈성유전적인황달증으로알려져있으며 948 분담도폐쇄로특정지워져 Yeh 등, Kuni 듬 i 신등 7, 년 Rotor 등이기술한이래 Schiff 등, Haverback 등 - 646-
- 金重均外황탈의강별진단에있어서의간담도走잔의갚짧 - Table 0. Hepatobiliary Imaging in Rotor's syndrome Blood Test Case No. Bilirubin Alkaline Age T o아 ta 외l/Direct phosphatase (mg/dl) (IU/L) Imaging Finding Clearance Transit time Bile duct GB dilation. 23 yrs.t 남 6.8/4.0 2. 24 yrs. * 6.4/4.4 3. 9 yrs. *t 7.0/4.5 Mean:tS.D. 6.4:t 0.6/ 4.3 :t 0.3 37.0 30.6 80.5 49.4 :t 27.2 3 3 hrs. none 3 hrs 3 30 min. none 30 min 3 45 min none 45 min 3 t Normally functioning GB in oral GB * Early onset such as 4-6 years t Familial tendancy of similar jaundice 에의해추가보고되었고 Dubin-Johnson 증후군과 고정상의담도로의배설을관찰할수있겠다 io 등 는다음과같은점에있어서디르다고하겠다 23, 2샤 5, 26, 29 은 3 -BSP 와 3 - ros e bengal 을이용하여 심한간여과율의저하, 강한배후방사능, 경미한간 첫째간세포내의반점이없다. 실질시간의지연을보고하였고. Bar-Meir 등 Dl 은 둘째 Rotor 증후군은경구담낭조영술상 담냥의 99m Tc- HI DA 를이용심한간여과율의저하와강한 조영을볼수있A 나, Dubin-Johnson 증후군은 담 배후방사능, 그리고 24 시간까지담도가조영되지 않 낭의조영을볼수없다. 는소견을기술하였다. 저자들은 3 예의 Rotor 증후군 셋째 Rotor 증후군에서는혈장의 )3romosulfuphthalein 에서 99 m Tc-DISIDA를사용제 3 등급의심한여과 (BSP) 이 90 분에서두번째정점을볼수없다. 율의저래강한 배후방사능, 그리고 30 분 ~ 3 시간 넷째 Rotor 증후군은民 coproporphyrin 배설의증 의경미한간실질통과시간의지연을보여 Iio등 ; Bar 가를보이나 coproporphyri n 이성체 m의증가를보이 -Meir 등의결과와동일하였다 (Fig.4). 지않는다. 또한직정당즙소치의상승, 다량의담즙을함유하 결 론 고있는진한소변등으로 Gilbert 증후군과 감별이 가능하며, 정상의 Alkaline phosphatase 치, 정상의 본순천향대학부속순천향병원에서 983 년 3 월부 경구담냥조영술및초음파소견그리고정상의간조 터 984 년 9 월까지 99m Tc - HI DA 또는 DI SIDA를 직소견등으로간내또는간외담도의담즙배설장애, 이용간담도走흉를실시황달의감별에도움이 되는 간세포장애등과감별이가능하다 2, 28 > 또한 Rotor 증후군과 Dubin- Johnson 증후군은 점을말견하였기에이에그결과를보고하는바이다. 간실질통과시간을황달의첫번째강별지표로 그병태생리에있어서 Rotor 증후군을유기음이온외 이용한배종양에의한폐쇄성황달群, 담석으로 인 혈장a로부터 간 로의이동 (transpor t) 의 장애, 간의 한폐쇄성황달群, 간세포성황달群, 세群간의 간 저장능력 (storage capacity) 의저하이며, 담도로의 실질통과시간의차이는동게학적으로매우유의하여 배셜은정상인반면 Dubin-Johnson 증후군은 유기 황달의감별진단에유용하였다 (p (O. Ol, X 2 - 險定 ). 음이온의간세포로부터담도細管 로의배설의 장애 2. 두번째지표로간여과율을사용한애부분담도 이다. 이와같은병태생리로부터 Du bin- J ohnson 증 폐쇄群과陽管能의출현을보인간세포성황달 群간 후군은강하고지속적인府 방사능성취와담도로의심 의간여과율의차이는통계학적으로매우유의성을보 한배설장애를관찰할수있겠고. Rotor 증후군은심 여 감별진단에유용하였다 (p (O.Ol, t- 險定 ). 한간여과융의저하와배후방사능의강한증가그리 3. 간외담도폐쇄성황달을감별호L 에 있어, 종 $ 벼l - 647-
大후 ;~ñx M 綠양!l 4 -í 칸誌 第 2 卷짜 4 號 985 - 의한담도펴! 쇄群그리고담석에의한담도폐쇄群, 상기두群간의간여파율의차이는통계학적 S로유의성을보이지않았다 (P>O. 05, X 2 - 險定 ) L 담도확장유무의차이는, 종양에의한담도펴 쇄群, 간세포성황달群, 상기세群간의통계학적인유의성을보여감별진단에유용하였다 (p < O. 05, X' 險定 ). 5 " 담석이! 의한폐쇄성황달중간내담석은지속적인간내방시능의축적, 그리고부분담도폐쇄의소찬을보여진단에도움을주었다. 6. Rotor 씨증후군은간담도走좁소견상심한간여과율의저하, 강한배후방사능, 경미한간실질통과시간의지연, 정상의담낭조영응을보여 Du bin - J ohnson 증후군과강별이되었마. REFERENCES. Rosenthall L: Cho/escintigraphy in the prescence of jaun. dice utilizing 99m Tc-IOA. 5eminars in Nuc/ear Medicine 2:53-63, 982 2. 5ample WF, 5arti DA, Goldstein LI et al Cray scale ultrasonorgraphy of the jaundiced patients. Radiology 28:79-725, 978. 3. Harvey E, Loberg M, Cooper M: 99mTc-HIDA; a new radiophamaceutical for hepatobiliary imaging. j Nuc/ Med 6:533, 975 4. Loberg M, Cooper M, Harvey E et al: Oevelopmenmt of new radiophamaceuticals based on N-substitation of iminodiacetic acid. j Nuc/ Med 7:633-638, 976 5. Klingensmith WC, Kuni CC, Fritzberg AR: Chol/escin tigraphy in extrahepatic biliary obstruction. AjR 39:65-70, 982 6. Kuni Cζ Klingensmith Wc, Fritzberg AR: Evaluation of intrahepatic cho/estasis with radionuc/ide hepatobiliary imaging. Castrointest Radiol 9:63-66, 984 7. Kuni CC, Klingensmith W C: Atlas of radionuc/ide hepatobiliary imaging. st Ed: 2-23, C.K. Hal/ ιedical Publishers, 8oston, ιassach us etts, 983 8. Yeh 5H, Li u OK, Huang MJ: 5equential5cintigraphy with Technetium-99m-Pyridoxylidenglutamate in the detection of intraphepatic lithiasis. j Nuc/ Med 2:7-2, 980. 9. Taplin GV, Meredith OM, Kade H: The radioactive ( 37 tagged) rose bangal uptake-excretion test. for liver function using external gamma ray scintillation counting techniques. j Lab Clin Med 45:665-678, 955 0. Winston MA, Blahd WH: l3l-rose bengal imaging techni ques in differential diagnosis 0 jaundiced patients. 5emin Nucl κ~ed 2:67-75, 972. Wistow BW, 5ubramanian G, Van Heertum RL et al: An application 99m Tc-labeled hepatobiliary agents. j Nuc/ ιled 8:455-46, 977 2. Wistow BW, 5ubramanian G, Gagne GM et al: Experimental and c/inical trials of new 99mTc-labeled hepatobiliary agents. Radiology 28:793-794, 978 3. Kl ingensmith Wι Fritzberg AR, Koep et al: A c/inical comparison of 99m Tc-Oiethyl-lminodiacetic acid, 99m Tcpyridoxylideneglutamate, and 737 /-rose begal in liver transplant patients. Radiology 30:435-44, 979 4. Reichelt HG, Popsescu HI : The importance of liver uptake and retention indices in assessment of c/inical usefulness of hepatobiliary imaging agents. j Nuc/ Med 20 7-72, 979 5. Fonseca C, Rosenthall L, Greenberg D et al: Oifferential diagnosis of jaundice by 99mTc-IOA hepatobiliary imaging. Clin Nuc/ Med 4:35-42, 979 6. Rosenthall L, 5haffer EA, Lisbona R et al: Oiagnosis of hepatobiliary disease by 99mTc-IOA cholescintigraphy. Radiology 26:467-474, 978 7. Pauwels 5. 5teels M. Beekers C: Clinical evaluation of 99m Tc-Oiethyl-IOA in hepatobiliary disorders j Nuc/ Med 9:783-788, 978. 8 김정화, 오기찬, 배병호등 99mTc_ Diethyl- DA 를이용한간담도조영술. 대한방사선의학회지 7 302-308. 98 9 서진석, 정태섭, 이종두등 : Tc-99m-HIDA를이용한간담도계질환의임상적연구. 대한방사선의학회지 8:39-48, 982 20 김용가, 정덕수, 깅옥동등 99mTc - DI S IDA 를이용한간담도계질환의고찰. 대한방사선의학회지 2:480-489, 985 2. Mags 5, Morel A5: 5urgical experience with cholangiohepatitis (Hong Kong diseas리 in Canton Chinese. Ann 5urg 62:87-90, 965 22 신성해, 이영렬, 이명철등 99 m Tc-HIDA S can에서국소적간담도게확장을보인예의감별진단에관한연구 ( 초록 ). 대한핵의학회지 7: 09, 983 23. Rotor AB, Manahan L, Florenthin A: Familial non-hemolytic jaundice with direct van den Bergh reaction. Acta Med - 648-
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