견관절 자기공명 관절조영술에서 고식적 전방 접근법과 비교한 투시유도하 후방 접근법

Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

  • 유고은 (CHA의과학대학교 분당차병원 영상의학과학교실) ;
  • 하두회 (CHA의과학대학교 분당차병원 영상의학과학교실) ;
  • 이상민 (CHA의과학대학교 분당차병원 영상의학과학교실)
  • Yoo, Ko-Un J. (Department of Radiology, CHA Bundang Medical Center, CHA University College of Medicine) ;
  • Ha, Doo-Hoe (Department of Radiology, CHA Bundang Medical Center, CHA University College of Medicine) ;
  • Lee, Sang-Min (Department of Radiology, CHA Bundang Medical Center, CHA University College of Medicine)
  • 발행 : 2011.10.01

초록

목적: 어깨 관절의 자기공명 관절조영술의 고식적 전방 천자와 비교한 투시유도하 후방 천자의 유용성을 알아보고자 하였다. 대상과 방법: 전향적 연구로서 병원의 의학연구윤리심의위원회의 승인을 받았고, 환자의 동의서를 받았다. 증상이 있는 59명의 어깨 관절 60예의 어깨 관절의 자기공명 관절조영술 중 각각 30예씩 투시유도하에 전방 천자와 후방 천자를 시행하였다. 5단계 시각 통증 등급을 이용하여 시술의 통증 정도를 평가하였고, 천자의 깊이, 환자의 신체 질량 지수로 표준화한 천자의 깊이를 측정하였다. 자기공명영상에서 천자 경로를 따른 조영제의 누출을 분석하였다. 두 군의 차이를 Mann-Whitney U test와 Kruskal-Wallis test를 이용하여 통계 분석하였다. 결과: 각 군 환자의 나이와 성별은 차이가 없었다. 시각 통증 등급은 전방과 후방군 각각 1.77 ${\pm}$ 1.10과 1.80 ${\pm}$ 0.96으로 통계학적 차이가 없었다. 전방군과 비교하여 후방군의 천자 깊이는 6.6 ${\pm}$ 0.9 cm와 4.4 ${\pm}$ 0.8 cm로 유의하게 짧았고(p < 0.001), 신체 질량 지수로 표준화한 천자의 깊이도 2.8 ${\pm}$ 0.4 cm와 1.8 ${\pm}$ 0.3 cm로 통계적으로 유의한 차이를 보였다(p < 0.001). 천자 경로 주위의 조영제 누출은 후방군에서 의미있게 더 많았다(p = 0.003). 결론: 어깨 관절 자기공명 관절조영술에서의 후방 천자는 관절내 전방에 병변이 의심되는 환자, 수술 후 추적검사 또는 비만 환자에서 유용할 것이다.

Purpose: To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance (MR) arthrography. Materials and Methods: Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. Results: There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ${\pm}$ 1.10 vs. 1.80 ${\pm}$ 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ${\pm}$ 0.8 cm and 1.8 ${\pm}$ 0.3 cm vs. 6.6 ${\pm}$ 0.9 cm and 2.8 ${\pm}$ 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). Conclusion: The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient.

키워드

참고문헌

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