Langerhans Cell Histiocytosis in the Skull: Comparison of MR Image and Other Images

두개골의 랑게르한스 세포 조직구증: 자기공명영상과 다른 영상과의 비교

  • Lim, Soo-Jin (Department of Radiology, Inha University, College of Medicine) ;
  • Lim, Myung-Kwan (Department of Radiology, Inha University, College of Medicine) ;
  • Park, Sun-Won (Department of Radiology, Inha University, College of Medicine) ;
  • Kim, Jung-Eun (Department of Radiology, Inha University, College of Medicine) ;
  • Kim, Ji-Hye (Sungkyunkwan University, Samsung Medical Center) ;
  • Kim, Deok-Hwan (Department of Electronic Engineering, Inha University) ;
  • Lee, Seok-Lyong (School of Industrial and Management Eng. Hankuk University of Foreign Studies) ;
  • Suh, Chang-Hae (Department of Radiology, Inha University, College of Medicine)
  • 임수진 (인하대학교 의과대학 영상의학과학교실) ;
  • 임명관 (인하대학교 의과대학 영상의학과학교실) ;
  • 박선원 (인하대학교 의과대학 영상의학과학교실) ;
  • 김정은 (인하대학교 의과대학 영상의학과학교실) ;
  • 김지혜 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김덕환 (인하대학교 전자공학과) ;
  • 이석룡 (한국외국어대학교 산업경영공학부) ;
  • 서창해 (인하대학교 의과대학 영상의학과학교실)
  • Published : 2009.06.30

Abstract

Purpose : To evaluate the characteristic MR imaging findings of Langerhans cell histiocytosis (LCH) in the skull and to compare them with those of plain radiography and computed tomography. Materials and Methods : A total of 10 lesions in 9 patients (Age range; 5-42 years, Mean age; 18, all women) with Langerhans cell histiocytosis in the skull were included in our study. Nine lesions in nine patients were histologically confirmed by surgery or fine needle aspiration biopsy. All patients performed with MRI, and plain radiography and CT scan were done in 7 patients (8 lesions). Two experienced neuroradiologists reviewed the radiological examinations independently with attention to location, size, shape and nature of the lesions in the skull and compared the extent and extension of the lesions to adjacent structures. Results : The lesions were distributed in all of the skulls without predilection site. On MRI, the masses were shown as well-enhancing soft tissue masses (10/10) mainly in diploic spaces (8/10) with extension to scalp (9/10) and dura mater (7/10). Dural enhancement (7/10) and thickening (4/10) were seen. The largest diameter of the soft tissue masses ranged 1.1 cm to 6.8 cm, shaped as round (5/10) or oval (5/10). On CT scans, the lesions were presented as soft tissue masses involving diploic space (6/8) and scalp extension (7/8) were also well visualized. Although bony erosion or destruction was more clearly seen on CT rather than those of MRI, enhancement of soft tissue masses and dura were not well visualized on CT. In contrast, all of the lesions in LCH were seen as punched out (4/8), beveled-edge appearance (4/8) osteolytic masses in plain radiography, but scalp and dural extension could not be seen. Conclusion : Characteristic MR findings in patients with LCH are soft tissue mass in diploic space with extension to dura and scalp, and MRI would be better imaging modality than plain radiography or CT.

목적: 이 연구의 목적은 두개골 랑게르한스 세포 조직구증의 특징적인 자기공명 영상소견을 기술하고 단순촬영과 컴퓨터 단층 촬영에서의 영상소견과 비교함에 있다. 대상 및 방법: 총 9명의 환자 중 10예의 병변을 대상으로 자기공명 영상을 분석하였다(연령범위: 5-42세, 평균 연령: 18세, 전예 여자). 9예에서 수술이나 미세 침 흡입 생검술에 의해서 병리학적으로 두개골의 랑게르한스 세포 조직구증이 증명되었다. 모든 환자는 자기공명영상을 시행하였고 이 중 7명 (8예) 에서 컴퓨터 단층 촬영과 단순 촬영을 시행하였다. 두 명의 숙련된 신경영상의학 의사가 영상에서 병변의 위치, 크기, 모양과 특징을 독립적으로 분석하고 병변의 범위와 주변 조직으로의 침범 여부를 비교하였다. 결과: 병변은 모든 두개골에 편향 없이 분포하였다. 자기공명 영상에서 종괴들은 조영증강되는 골 융해성 종괴(10/10)로 주로 판사이 공간에 위치하고(8/10) 두피(9/10)나 경질막(7/10)을 침범하였다. 경질막의 조영증강(7/10)과 비후(4/10)가 모든 병변에서 보였다. 골 융해성 종괴의 크기는 1.1 cm에서 6.8 cm의 범위였으며 모양은 원형(5/10)이거나 난원형(5/10)이었다. 컴퓨터 단층 촬영에서 병변은 판사이 공간의 골 융해성 종괴로(6/8) 두피의 침범(7/8)이 잘 보였다. 컴퓨터 단층촬영에서 골미란이나 골파괴가 자기공명영상보다 좀 더 분명하게 보였지만 연부종괴와 경질막의 조영증강 유무는 판단하기 어려웠다. 이와 대조적으로 단순촬영에서 모든 랑게르한스 세포 조직구증은 도려낸 병터 (punched out) 모양(4/8)이나 beveled-edge 모양(4/8)의 골융해성 종괴로 보였고 두피나 경질막으로의 침범은 판단 할 수 없었다. 결론: 두개골 랑게르한스 세포 조직구증의 특징적인 자기공명 영상소견은 판사이 공간에 위치한 골 융해성 종괴가 경질막과 두피를 침범하는 것으로, 자기공명영상이 단순촬영이나 컴퓨터 단층 촬영 보다 우월한 영상 기법이다.

Keywords

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