Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases

다양한 원발성 암의 척추전이 병변의 특징적인 자기공명영상 소견들: 병리학적으로 확인된 병변들의 후향적인 분석

  • An, Chansik (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Lee, Young Han (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Sungjun (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Cho, Hee Woo (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Suh, Jin-Suck (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Song, Ho-Taek (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine)
  • 안찬식 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 이영한 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 김성준 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 조희우 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 서진석 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 송호택 (연세대학교 의과대학 세브란스병원 영상의학과)
  • Received : 2012.07.17
  • Accepted : 2013.02.19
  • Published : 2013.04.30
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Abstract

Purpose : The purpose of this study was to find and categorize the various magnetic resonance imaging (MRI) findings of spinal metastases that correlate with the type of primary cancer. Materials and Methods: We retrospectively reviewed gadolinium-enhanced magnetic resonance images of 30 patients with 169 spinal metastatic lesions from lung cancer (n = 56), breast cancer (n = 29), colorectal cancer (n = 20), hepatocellular carcinoma (HCC) (n = 17), and stomach cancer (n = 47). The size, location, extent of invasion, signal intensity, margin, enhancement pattern, and osteoblastic or osteolytic characteristics of each metastatic tumor were analyzed. Results: The metastatic lesions from HCC were larger than those from the other primary tumors (P < 0.05) except for colorectal cancer (P = 0.268). Well-defined metastatic tumor margins were more frequently seen in lung cancer and breast cancer (P < 0.01). All but HCC showed a tendency to invade the vertebral body rather than the posterior elements (P < 0.02). Colorectal cancer and HCC showed a tendency toward extraosseous invasion without statistical significance. HCC showed a characteristic enhancement pattern of 'worms-in-a-bag'. Rim enhancement with a sclerotic center was only seen in spinal metastases from stomach cancer. Conclusion: Despite many overlapping imaging features, spinal metastases of various primary tumors display some characteristic MRI findings that can help identify the primary cancer.

목적: 척추전이의 자기공명영상 소견들 중 특정 원발성 암에 특이적인 소견들이 있는지 알아보고자 한다. 대상과 방법: 본 연구에서는 자기공명영상을 시행한 총 169개의 척추전이암 병변들 (56개는 폐암, 29개는 유방암, 20개는 대장암, 17개는 간세포암, 그리고 47개는 위암으로부터 기원)을 후향적으로 분석하였다. 각 병변의 크기, 위치, 침범 정도, 신호강도, 경계, 조영증강 양상, 그리고 골융해/골경화 특성들을 분석하여 원발성 암의 기원에 따라 차이가 있는지 보았다. 결과: 간세포암의 전이 병변들은 대장암을 제외하고는 (P=0.268) 다른 암에 비하여 크기가 유의하게 컸다 (P < 0.05). 경계가 좋은 병변은 폐암과 유방암에서 기원한 경우에서 더 흔히 관찰되었다 (P < 0.01). 간세포암을 제외한 모든 암에서 전이를 할 때 척추의 후부요소보다 척추체를 더 자주 침범하였다(P < 0.02). 대장암과 간세포암은 골외 침범을 더 자주 보였으나 통계학적 의미는 없었다 (P > 0.05). 간세포암과 위암의 전이병변들은 특징적인 조영증강 양상을 보였다. 결론: 일부 자기공명영상 소견들은 척추전이 병변이 어떤 원발성 암에서 기원한 것이지 예측하는 데 도움이 될 수 있다.

Keywords

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