Parasite | Eso | Sto | Cancer | ESD
[Dr. Sinn's LiverTODAY 008 - Gadolinium]
¾ÆÁÖ Áß¿äÇÑ ÀÚ·á°¡ JAMA¿¡ ¹ßÇ¥ µÇ¾ú½À´Ï´Ù (Ray JG. JAMA 2016) .
°£Áúȯ¿¡¼ ¸¹ÀÌ È°¿ëµÇ´Â °Ë»ç Áß Çϳª°¡ Gadolinium-Enhanced MRIÀÔ´Ï´Ù. Gadolinium Àº "rare-earth metal"·Î ÁöÁúÇÐÀÚÀÎ Johan GadolinÀ» ±â³äÇϱâ À§ÇÑ Atomic number 64¸¦ °¡Áø ¹°ÁúÀÔ´Ï´Ù.
Paramagnetic propertie¸¦ °¡Áö°í ÀÖ°í, °£Áúȯ¿¡¼ ³Î¸® ¾²À̴°ÍÀÌ hepatocyte¿¡ uptake°¡ µÇ¾î, Á¤»ó°ú ºñÁ¤»ó¼¼Æ÷¸¦ ±¸ºÐÇϴµ¥ ¾ÆÁÖ À¯¿ëÇÕ´Ï´Ù. º¸Åë 20ºÐ hepatobiliary phase image¶ó°í Çϴµ¥, Gadolinium enhanced MRI¿¡¼´Â 20ºÐ ¿µ»ó¿¡¼ Á¤»ó °£¼¼Æ÷´Â uptake°¡ µÇ¾î ÇϾé°Ô º¸À̴µ¥, ºñÁ¤»ó ¼¼Æ÷µéÀº uptakeµÇÁö ¾Ê¾Æ °ËÀº defect·Î º¸ÀÔ´Ï´Ù. ÀÌ Æ¯¼ºÀ» ÀÌ¿ëÇÏ¿© ¸Å¿ì ¹Î°¨ÇÏ°Ô º´º¯À» È®ÀÎÇÒ ¼ö ÀÖ½À´Ï´Ù. ¸ÞŸºÐ¼®¿¡ µû¸£¸é GadoliniumÀ» »ç¿ëÇÑ MRI´Â ´Ù¸¥ °Ë»ç¿¡ ºñÇØ Á¾¾çÀ» ¹ß°ßÇÏ´Â ¹Î°¨µµ°¡ 74%¿¡¼ 87%·Î À¯ÀÇÇÏ°Ô ÁÁ¾ÆÁý´Ï´Ù (Lee JY. Radiology 2015).
Á¤»ó °£¿¡ ºñÇØ Á¾¾çÀÌ ÀÖ´Â ºÎºÐÀº 20ºÐ Áö¿¬±â ¿µ»ó¿¡¼ gadolinium uptake°¡ ¾ø¾î °Ë°Ô º¸ÀÓ
Gadolinium Àº µå¹°Áö¸¸ ¸Å¿ì À¯¸íÇÑ ÇÕº´ÁõÀÎ nephrogenic systemic fibrosis°¡ ÀÖ½À´Ï´Ù. ÁÖ·Î Åõ¼®È¯ÀÚ µî ½ÅºÎÀü ȯÀÚ¿¡°Ô ¹ß»ýÇÕ´Ï´Ù.
À̹ø JAMA¿¡ Gadolinium MRI°¡ ÀÓ»êºÎ¿¡°Ô´Â À§ÇèÇÒ ¼ö ÀÖ´Ù´Â ¿¬±¸°á°ú°¡ º¸°íµÇ¾ú½À´Ï´Ù. "Gadolinium MRI at any time during pregnancy was associated with an increased risk of a broad set of rheumatological, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death" (Ray JG. JAMA 2016) Gadolinium MRI¸¦ ó¹æÇÒ ¶§ ¹Ýµå½Ã ÀӽŠ¿©ºÎ¸¦ È®ÀÎÇսôÙ.
ÀÌÁØÇà ±³¼ö´Ô. ¾È³çÇϽʴϱî. Àú´Â ¼¿ï¾Æ»êº´¿ø¿¡¼ ³»°ú Æ®·¹ÀÌ´× ÈÄ ±ºº¹¹« ÁßÀÎ ±èÇüµ·ÀÔ´Ï´Ù. ÀÓ»ó¿¡¼ ÇÑ¹ß ¶³¾îÁ®ÀÖ´Â Áß¿¡ ¸Å¹ø ÁÁÀº Á¤º¸ °¨»çµå¸³´Ï´Ù. À۳⿡ ¾Æ»êº´¿ø¿¡¼ ÇØÁֽŠ¹ßÇ¥ °ü·Ã °Àǵµ ¸Å¿ì µµ¿òÀÌ µÇ°í ÀÖ½À´Ï´Ù (EndoTODAY ÇÐȸ¹ßÇ¥ checklist).
¿À´Ã º¸³»ÁֽŠgadolinium °ü·Ã ³»¿ëµµ ¸Å¿ì Áß¿äÇÑ ³»¿ëÀÌ¾î¼ Àλó ±í°Ô º¸¾Ò½À´Ï´Ù. ´Ù¸¸ ¿À´Ã º¸³»ÁֽŠ³»¿ë Áß ¾à°£ÀÇ ±¸Ã¼È°¡ ÇÊ¿äÇÑ ºÎºÐÀÌ ÀÖÀ» °Í °°¾Æ ¸ÞÀÏÀ» ¿Ã¸³´Ï´Ù. À߸ø µÇ¾ú´Ù´Â ¶æÀº Àý´ë ¾Æ´Õ´Ï´Ù.
Hepatocyte¿¡ specificÇÏ°Ô uptakeµÇ°í 20ºÐ hepatobiliary phase¸¦ º¼ ¼ö ÀÖ°Ô ÇØÁÖ´Â Á¶¿µÁ¦ Áß ÃÖ±Ù ¸¹ÀÌ »ç¿ëÇÏ´Â Á¶¿µÁ¦´Â gadoxetic acidÀÔ´Ï´Ù. ÀÌ´Â gadolinium-based moleculeÀ̱ä ÇÏÁö¸¸ gadolinium °è¿ÀÇ Á¶¿µÁ¦ Áß¿¡´Â hepatocyte specific property°¡ ¾ø´Â moleculeµµ ¸¹±â ¶§¹®¿¡ ±¸ºÐÀÌ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.
¾Æ·¡¿¡ Á¦°¡ 1ÀúÀÚ·Î ½è´ø ³í¹®¿¡ gadoxetic acid¿Í non-gadoxetic acid¸¦ »ç¿ëÇÑ MR imaging·Î stagingÇßÀ» ¶§ ¿¹Èĸ¦ º» ³»¿ëÀÌ ÀÖ½À´Ï´Ù (Kim DH. Gastroenterology 2015). Âü°í ºÎŹµå¸³´Ï´Ù.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) has a high rate of intrahepatic recurrence after curative treatment, possibly because metastases are not always identified before treatment. Magnetic resonance (MR) imaging with a liver-specific contrast agent, gadoxetic acid, can detect small HCCs with high levels of sensitivity. We investigated whether MR imaging with gadoxetic acid increases overall and recurrence-free survival of patients initially assessed by computed tomography (CT).
METHODS: We performed a retrospective study of data from 700 patients diagnosed with a single-nodular HCC by dynamic 4-phase CT in Seoul, Korea, from January 2009 through December 2010. Of these patients, 323 underwent additional evaluation with gadoxetic acid-enhanced MR imaging (CT+MR group). The 377 patients who did not undergo MR imaging analysis are referred to as the CT group.
RESULTS: The CT and CT+MR groups were comparable in most baseline characteristics (Child-Pugh class A, 93.1% vs 94.7%; and median size of the primary HCCs, 2.8 vs 2.6 cm, respectively). Seventy-four additional HCC nodules were detected in 53 (16.4%) of the patients who underwent MR evaluation after CT (CT+MR group). These detections increased the Barcelona Clinic Liver Cancer stages for 43 patients (13.3%) and modified their treatment plans. On multivariable analyses, the CT+MR group had a significantly lower rate of HCC recurrence (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54-0.96) and lower overall mortality (HR, 0.65; 95% CI, 0.44-0.96) than the CT group. In an analysis of 285 pairs of patients matched on the basis of the propensity score, the CT+MR group had significantly lower overall mortality (HR, 0.66; 95% CI, 0.44-0.99).
CONCLUSIONS: Among patients who underwent dynamic CT analysis of a single-nodular HCC, additional evaluation by MR imaging with gadoxetic acid led to the detection of additional HCC nodules in 16% of patients, reduced the risk of disease recurrence, and decreased overall mortality.
¾ÕÀ¸·Îµµ ÁÁÀº ³»¿ëÀ¸·Î ¸¹Àº °¡¸£Ä§ ºÎŹµå¸³´Ï´Ù. Ç×»ó °¨»çµå¸³´Ï´Ù.
[2016-9-9. ½Åµ¿Çö ±³¼ö´Ô ´äº¯]
Gadolinium-based Á¶¿µÁ¦ Áß hepatocyte specific property°¡ ÀÖ´Â Á¶¿µÁ¦´Â Gadoxetic acid (Gd-EOB-DTPA) based MRIÀ̱⠶§¹®¿¡, ¾Öµ¶ÀÚÀÇ comment¸¦ °í·ÁÇÏ¿© ÇØ´ç ºÎºÐÀ» ¾Æ·¡¿Í °°ÀÌ º¯°æÇÏ´Â °ÍÀÌ ´õ ÁÁ°Ú½À´Ï´Ù.
"Gadolinium based contrast Áß hepatocyte specific property°¡ ÀÖ´Â Gadoxetic acid (Gd-EOB-DTPA) based MRI¼´Â 20ºÐ ¿µ»ó¿¡¼ Á¤»ó °£¼¼Æ÷´Â uptake°¡ µÇ¾î ÇϾé°Ô º¸À̴µ¥, ºñÁ¤»ó ¼¼Æ÷µéÀº uptakeµÇÁö ¾Ê¾Æ °ËÀº defect·Î º¸ÀÔ´Ï´Ù. ÀÌ Æ¯¼ºÀ» ÀÌ¿ëÇÏ¿© ¸Å¿ì ¹Î°¨ÇÏ°Ô º´º¯À» È®ÀÎÇÒ ¼ö ÀÖ½À´Ï´Ù. ¸ÞŸºÐ¼®¿¡ µû¸£¸é Gadoxetic acid (Gd-EOB-DTPA) based MRI¸¦ »ç¿ëÇÑ MRI´Â ´Ù¸¥ °Ë»ç¿¡ ºñÇØ Á¾¾çÀ» ¹ß°ßÇÏ´Â ¹Î°¨µµ°¡ 74%¿¡¼ 87%·Î À¯ÀÇÇÏ°Ô ÁÁ¾ÆÁú »Ó ¾Æ´Ï¶ó (Lee JY. Radiology 2015), dynamic CT¿¡¼ ´ÜÀÏ°áÀý·Î ¹ß°ßµÈ ȯÀںеé Áß Gadoxetic acid (Gd-EOB-DTPA) based MRI¸¦ Ãß°¡·Î ¹ÞÀº ºÐµéÀº dynamic CT·Î °Ë»çÇÑ °Í¿¡ ºñÇØ 16%¿¡¼ »õ·Î¿î º´º¯À» ´õ ¹ß°ßÇÏ¿´°í, ÁúȯÀÇ Àç¹ß·üÀ» ÁÙÀÌ°í overall mortality¸¦ °¨¼ÒÇÏ¿´´Ù´Â °ÍÀÌ º¸°íµÈ ¹Ù ÀÖ½À´Ï´Ù (Kim DH. Gastroenterology 2015)"
Gadolinium-based MRI´Â ¼¼ºÎÀûÀÎ Á¶¿µÁ¦ÀÇ Æ¯¼º¿¡ µû¶ó nephrogenic systemic fibrosis (NSF)ÀÇ À§Çèµµ Â÷ÀÌ°¡ ÀÖ´Ù°í ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù.
ÁÁÀº ÁöÀûÀ» ÇØÁֽŠ±èÇüµ· ¼±»ý´Ô²² °¨»çµå¸³´Ï´Ù.
[2016-9-10. ÀÌÁØÇà ´äÀå]
ÁÁÀº ÀÇ°ßÀ» ÁֽŠ±èÇüµ· ¼±»ý´Ô°ú LiverTODAY ³»¿ëÀ» º¸ÃæÇØÁֽŠ½Åµ¿Çö ±³¼ö´Ô²² °¨»çµå¸³´Ï´Ù.
ºñ·Ï Á¦°¡ °£Áúȯ Àü°øÀº ¾Æ´ÏÁö¸¸, À̹ø LiverTODAY¸¦ ÅëÇÏ¿© Gadolinium MRI¸¦ Á» ´õ ÀÌÇØÇÒ ¼ö ÀÖ¾î Áñ°Ì½À´Ï´Ù. ¿ì¸®³ª¶ó ¼±»ý´ÔµéÀÌ ÈǸ¢ÇÑ Àú³Î¿¡ ¹ßÇ¥ÇÑ ³í¹®µéÀ» ÅëÇÏ¿© Åä·ÐÇÒ ¼ö ÀÖ¾î¼ Áñ°Å¿ü°í, ±èÇüµ· ¼±»ý´Ô ³í¹®(Kim DH. Gastroenterology 2015)ÀÇ ±³½ÅÀúÀÚ°¡ Á¦ Ä£±¸À̱⵵ ÇÑ ¾Æ»êº´¿ø ÀÓ¿µ¼® ±³¼öÀÎ °ÍÀ» º¸°í ´õ¿í Áñ°Å¿ü½À´Ï´Ù. ¸Å¿ì ±âºÐ ÁÁÀº ³¯ÀÔ´Ï´Ù.
±èÇüµ· ¼±»ý´Ô²²¼ ¾ð±ÞÇϽŠÀúÀÇ ¾Æ»êº´¿ø °ÀÇ ÀÚ·á´Â ¾Æ·¡ link¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.
*Âü°í: EndoTODAY ÇÐȸ¹ßÇ¥ checklist (WORD ¹®¼)
1) EsoTODAY - Esophageal diseases
2) SmallTODAY - Small bowel diseases
3) ColonTODAY - Colorectal diseases
4) Dr. Sinn's LiverTODAY - Liver diseases
© ¼º±Õ°ü´ëÇб³ ÀÇ°ú´ëÇÐ »ï¼º¼¿ïº´¿ø ¼Òȱ⳻°ú ½Åµ¿Çö (2016-9-9)