대한핵의학회지 (The Korean Journal of Nuclear Medicine)

대한핵의학회 (The Korean Society of Nuclear Medicine)
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홍역 후 발생된 급성 뇌염 진단시 Tc-99m ECD 뇌혈류 SPECT의 임상적 유용성

The Clinical Usefulness of Tc-99m ECD Brain SPECT in Acute Measles Encephalitis

  • 임석태 (전북대학교 의과대학 핵의학교실) ;
  • 손명희 (전북대학교 의과대학 핵의학교실)
  • Lim, Seok-Tae (Departments of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Sohn, Myung-Hee (Departments of Nuclear Medicine, Chonbuk National University Medical School)
  • 발행 : 2003.08.30
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초록

목적: 홍역 감염 후 속발되는 뇌염은 사망률이 높아 조기진단 및 적극적인 치료가 예후에 중요하다. 저자들은 홍역 후 발생된 뇌염에 대한 Tc-99m ECD 뇌혈류 SPECT와 뇌핵자기공명영상(MRI)의 진단 성능을 비교하였고 뇌혈류 SPECT상 중등도 이상의 심한 뇌혈류 감소가 호발하는 부위를 알아보았다. 대상 및 방법: 홍역으로 진단받은 112명 중에서 의식저하, 경련, 마비 등의 임상증상과 혈청 및 뇌척수액에서 홍역 특이항체가 관찰되어 홍역 후 급성 뇌염으로 진단받고 Tc-99m ECD 뇌혈류 SPECT와 MRI를 시행받은 11명(M : F=4 : 7, 연령 $1.6{\sim}14$세)을 대상으로 하였다. SPECT상 관찰되는 뇌혈류는 0(정상)에서 3(결손)으로 점수화하였고 2점 이상인 경우를 중등도 뇌혈류 감소로 정의하였다. 홍역 후 발생된 뇌염 환아에서 MRI와 SPECT의 두부병소 진단 성능과 중등도 뇌혈류 감소의 호발부위를 알아보았다. 결과: MRI 시행결과 7명(63.6%)에서 T2-강조영상에서 회백질의 고강도 변화가 관찰되었으나, SPECT상 11명(100%) 모두에서 뇌혈류 감소 부위가 관찰되었다. 중등도 뇌혈류 감소는 전두엽(81.8%), 측두엽(72.7%), 후두엽(27.3%), 기저핵(27.3%), 두정엽(9.1%) 순서로 호발하였다. 결론: 홍역 후 발생된 뇌염 환아에서 두부병소를 진단하는데 MRI에 비하여 Tc-99m ECD 뇌혈류 SPECT가 좀더 도움이 될 것으로 사료된다.

Purpose: Since the prognosis of measles encephalitis is poor, early diagnosis and proper management are very important to improve clinical outcomes. We compared Tc-99m ECD brain SPECT (SPECT) with MR imaging (MRI) for the detection of acute measles encephalitis. Materials and Methods: Eleven patients(M : F=4 : 7, age range 18 months-14 yrs) with acute measles encephalitis were enrolled in this studies. All of them underwent both MRI and SPECT. The results of SPECT were scored from 0 (normal) to 3 (most severe defect) according to perfusion state. We compared two image modalities for the detection of brain abnormality in acute measles encephalitis. Results: Seven of 11 patients (63.6%) revealed high signal intensity in the white matter on T2WI of MRI, on the other hand all patients (100%) showed hypoperfusion on SPECT. Severe perfusion deficits above score 2 were located with decreasing frequencies in the frontal lobe (81.8%), temporal lobe (72.7%), occipital lobe (27.3%), basal ganglia (27.3%), and parietal lobe (9.1%). Conclusion: We conclude that SPECT is more useful than MRI for the detection of brain involvement in patients with acute measles encephalitis.

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