대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권3호
  • /
  • Pages.253-259
  • /
  • 2011
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

담낭의 분절형 선근종증: 담낭결석증 패턴의 CT를 이용한 평가

Segmental Adenomyomatosis of Gallbladder: CT Assessment of the Patterns of Cholecystolithiasis

  • 유연화 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 유정식 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 정재준 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 김주희 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 조은석 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 김대중 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 안지현 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 김기황 (연세대학교 의과대학 강남세브란스병원 영상의학과)
  • Yoo, Yeon-Hwa (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Yu, Jeong-Sik (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Chung, Jae-Joon (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Joo-Hee (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Cho, Eun-Suk (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Dae-Jung (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Ahn, Jhii-Hyun (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Ki-Whang (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine)
  • 발행 : 2011.03.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 담낭의 분절형 선근종증의 아형에 따라 동반하는 담낭결석의 특성을 분석하여 분절형 선근종증과 담석간의 상관관계를 확인하기 위함이다. 대상과 방법: CT에서 담낭에 석회화된 결석을 동반한 55명의 분절형 선근종증 환자들을 대상으로 담낭벽의 비후된 정도에 따라 아형을 나누었고(A형, 담낭벽의 비후가 좁아진 부위에 한정된 경우; B형, 담낭벽의 비후가 협착부위에서 기저부쪽으로 부분 확장된 경우; C형, 담낭벽의 비후가 협착부위뿐만 아니라 기저부구역 전체에 걸쳐 동반된 경우), 동반한 담석의 위치(경부 대 기저부)와 가장 큰 담석의 크기를 후향적으로 분석하였다. 담낭결석을 동반한 환자군과 담낭결석을 동반하지 않는 대조군에서 담낭의 비후된 정도를 비교하였다. 결과: 담낭의 분절형 선근종증에서는 기저부구역에서(48명) 경부구역보다(12명) 담석을 동반하는 경우가 많았다(p < 0.001). 동반한 담낭결석의 평균크기는 C형(($5.4{\pm}4.9$ mm)이 A형($2.3{\pm}2.2$ mm)에 비해 컸다(p=0.033). C형 분절형 선근종증은 담낭결석을 동반한 환자군에서의 빈도(69%)가 대조군에서의 빈도(49%)에 비해 높았다(p=0.012). 결론: CT에서 분절형 선근종증은 기저부구역에 담석을 많이 동반하며 담석을 동반할수록 그리고 담석의 크기가 클수록 담낭벽 비후의 범위가 넓으므로 분절형 선근종증이 담석의 생성과 담낭벽의 만성염증에 기여함을 알 수 있다.

Purpose: To clarify the relationship between the pattern of cholecystolithiasis and the gross features of segmental adenomyomatosis of the gallbladder. Materials and Methods: Fifty-five consecutive patients with segmental adenomyomatosis with calcified gallbladder stones defined on CT were retrospectively analyzed in terms of (i) stone location (fundal vs. neck compartment) and (ii) size of the largest stone as a function of the extent of segmental mural thickening (type A, limited at the narrow segment; type B, partially extended in the fundal direction; type C, involving the entire fundal compartment). The extent of segmental mural thickening in patients with cholecystolithiasis was compared with a control group (n = 48) lacking stones. Results: Stones were found more frequently in the fundal compartment in 48 patients compared to the neck compartment in 12 patients (p<0.001). The mean size of the largest stone in type C ($5.4{\pm}4.9$ mm) was larger than in type A ($2.3{\pm}2.2$ mm) (p=0.033). In patients with cholecystolithiasis, type C segmental thickening was predominant (69%) compared to the control group (42%) (p=0.012). Conclusion: In addition to a higher prevalence of stones, a wide extent of mural thickening combined with large stone size in the fundal compartment suggests the contribution of segmental adenomyomatosis to stone formation and chronic inflammation.

키워드

참고문헌

  1. Colquhoun J. Adenomyomatosis of the gall-bladder (intramural diverticulosis). Br J Radiol 1961;34:101-112 https://doi.org/10.1259/0007-1285-34-398-101
  2. Jutras JA. Hyperplastic cholecystoses; Hickey lecture, 1960. Am J Roentgenol Radium Ther Nucl Med 1960;83:795-827
  3. Kasahara Y, Sonobe N, Tomiyoshi H, Imano M, Nakatani M, Urata T, et al. Adenomyomatosis of the gallbladder: a clinical survey of 30 surgically treated patients. Nippon Geka Hokan 1992;61:190-198
  4. Tanno S, Obara T, Maguchi H, Fujii T, Mizukami Y, Shudo R, et al. Association between anomalous pancreaticobiliary ductal union and adenomyomatosis of the gall-bladder. J Gastroenterol Hepatol 1998;13:175-180 https://doi.org/10.1111/j.1440-1746.1998.tb00634.x
  5. Kurihara K, Mizuseki K, Ninomiya T, Shoji I, Kajiwara S. Carcinoma of the gall-bladder arising in adenomyomatosis. Acta Pathol Jpn 1993;43:82-85
  6. Nishimura A, Shirai Y, Hatakeyama K. Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis. J Hepatobiliary Pancreat Surg 2004;11:342-347 https://doi.org/10.1007/s00534-004-0911-x
  7. Ootani T, Shirai Y, Tsukada K, Muto T. Relationship between gallbladder carcinoma and the segmental type of adenomyomatosis of the gallbladder. Cancer 1992;69:2647-2652 https://doi.org/10.1002/1097-0142(19920601)69:11<2647::AID-CNCR2820691105>3.0.CO;2-0
  8. Klose KC, Persigehl M, Biesterfeld S, Gunther RW. Adenomyomatosis of the gallbladder in CT. Radiologe 1991;31:73-81
  9. Chao C, Hsiao HC, Wu CS, Wang KC. Computed tomographic finding in adenomyomatosis of the gallbladder. J Formos Med Assoc 1992;91:467-469
  10. Kim MJ, Oh YT, Park YN, Chung JB, Kim DJ, Chung JJ, et al. Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging 1999;24:410-413 https://doi.org/10.1007/s002619900526
  11. Nussle K, Brambs HJ, Rieber A. Adenomyomatosis of the gallbladder: ultrasound findings. Rontgenpraxis 1998;51:155-158
  12. Textbook of Gastrointestinal Radiology. In: Gore RM, Levin MS. 3rd ed. Philadelphia: Saunders/Elsevier, 2008:1446-1447
  13. Vilkin A, Nudelman I, Morgenstern S, Geller A, Bar Dayan Y, Levi Z, et al. Gallbladder inflammation is associated with increase in mucin expression and pigmented stone formation. Dig Dis Sci 2007;52:1613-1620 https://doi.org/10.1007/s10620-006-9162-9
  14. Domeyer PJ, Sergentanis TN, Zagouri F, Tzilalis B, Mouzakioti E, Parasi A, et al. Chronic cholecystitis in elderly patients. Correlation of the severity of inflammation with the number and size of the stones. In Vivo 2008;22:269-272
  15. Hsing AW, Gao YT, Han TQ, Rashid A, Sakoda LC, Wang BS, et al. Gallstones and the risk of biliary tract cancer: a populationbased study in China. Br J Cancer 2007;97:1577-1582 https://doi.org/10.1038/sj.bjc.6604047
  16. Owen CC, Bilhartz LE. Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis 2003;14:178-188
  17. Yang HL, Li ZZ, Sun YG. Reliability of ultrasonography in diagnosis of biliary lithiasis. Chin Med J (Engl) 1990;103:638-641