Investigative Magnetic Resonance Imaging

  • 제13권2호
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  • Pages.146-151
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  • 2009
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  • 2384-1095(pISSN)
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  • 2384-1109(eISSN)
대한자기공명의과학회 (Korean Society of Magnetic Resonance in Medicine)
권호 표지

척추염 환자의 약물치료기간 중 추적 검사한 MRI소견 변화의 임상적 중요성

Clinical Significance of MRI Findings During Medical Treatment for Tuberculous Spondylitis

  • 김대중 (연세대학교 강남세브란스병원 영상의학과) ;
  • 정태섭 (연세대학교 강남세브란스병원 영상의학과) ;
  • 서상현 (연세대학교 강남세브란스병원 영상의학과) ;
  • 김근수 (연세대학교 강남세브란스병원 신경외과) ;
  • 조용은 (연세대학교 강남세브란스병원 신경외과) ;
  • 윤영설 (연세대학교 강남세브란스병원 신경외과) ;
  • 김삼수 (강원대학교 강원대학교병원 영상의학과)
  • Kim, Dae-Jung (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Chung, Tae-Sub (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Suh, Sang-Hyun (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Keun-Su (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Cho, Yong-Eun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Yoon, Young-Sul (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Kim, Sam-Soo (Department of Radiology, Kangwon National University Hospital)
  • 발행 : 2009.12.30
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초록

목적: 비수술적 치료를 시행한 결핵성 척추염 환자의 MRI의 특징과 임상결과에 따른 MRI특징을 알아보고자 하였다. 대상과 방법: 2000년부터 2007년까지 임상적으로 결핵성 척추염을 진단 받은 환자 중 3개월 내에 수술적 치료를 받지 않은 환자를 대상하였으며 이중 최소한 3회 이상, 처음, 3개월 혹은 6개월 그리고 치료 종료시점상 MRI 검사를 시행한 환자를 연구군에 포함하여 후향적 분석을 시행하였다. 두 명의 영상의학과 의사가 모든 MR검사를 분석하였으며 임상결과와의 상관관계를 분석하였다. 결과: 열명(남:여=6:4, 평균나이=45세)의 환자가 연구대상 군에 포함되었으며 MR검사의 평균 추적검사기간은 10.1개월(4-17개월)이었다. 6명의 환자는 임상적으로 결핵성 척추염의 완치판정을 받았으며 4명의 환자는 3개월 이상 약물치료를 시행 받았으나 약물치료만으로는 완치되지 않아 추가적인 수술적 치료를 시행하였다. 모든 환자는 임상적 경과에 따라 두 군으로 분류하였으며 위의 6명은 완전 치료 군 4명은 불완전 치료 군으로 분류하였다. 완전 치료군의 MR특징은 결핵성 농의 인대 하 파급 및 농 자체의 크기감소, 척추체의 붕괴소견 없음 그리고 감염된 척추체의 지방변성이었음. 불 완전 치료군의 MR특징은 골수부종과 결핵성 농의 확장과 척추체의 붕괴였다. 결론: 결핵성 척추염의 비수술적 치료에 있어서 MRI는 치료반응을 예견하는데 한 역할을 담당할 것으로 생각된다.

Purpose : To evaluate magnetic resonance (MR) imaging features of non-surgically treated tuberculous spondylitis and to evaluate the relationships between these features and clinical outcomes. Materials and Methods : Data from ten patients (male:female=6:4, mean age=45 years) with clinically proven tuberculous spondylitis who were treated nonsurgically over three months were analyzed retrospectively from 2000 to 2007. MRI was performed at least three times for each patient, at baseline, every three or six months, and at the end of treatment. All images were analyzed by two radiologists. Results : The mean follow-up period for the MR examination was 10.1 months (range, 4-17 months). Six patients had clinically complete resolution of tuberculous spondylitis with medication treatment only. Four patients were treated with surgical management alongside medication. All ten patients were divided into two groups by clinical outcome; six patients with complete treatment and four patients with incomplete treatment. In the complete treatment group, follow-up MR findings showed a loss of subligamentous spread of abscesses, decreased size of abscesses, no interval changes in vertebral body heights, and fatty changes in spinal lesions. MR findings in the incomplete treatment group showed bone marrow edema extension to adjacent vertebra, extension of the abscesses, and decreased height of the vertebral bodies. Conclusion : During the nonsurgical management of tuberculous spondylitis, MR imaging may play a role in predicting patient response to antituberculous drug treatment.

키워드

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