Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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The Role of Diffusion-Weighted MRI in Differentiation of Idiopathic Acute Transverse Myelitis and Acute Spinal Cord Infarction

특발성 급성 횡단성 척수염과 급성 척수 경색의 감별에 있어서의 확산 강조 MR 영상의 의의

  • Kim, Yeo-Goon (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Joon-Woo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kim, Jae-Hyoung (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kang, Heung-Sik (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Park, Kyung-Seok (Department of Neurology, Seoul National University Bundang Hospital)
  • 김여군 (분당서울대학교병원 영상의학과) ;
  • 이준우 (분당서울대학교병원 영상의학과) ;
  • 김재형 (분당서울대학교병원 영상의학과) ;
  • 강흥식 (분당서울대학교병원 영상의학과) ;
  • 박경석 (분당서울대학교병원 신경과)
  • Published : 2011.08.01
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Abstract

Purpose: To compare the diffusion characteristics of idiopathic acute transverse myelitis (ATM) and acute spinal cord infarction (SCI). Materials and Methods: Diffusion-weighted images (DWI) and an apparent diffusion coefficient (ADC) map were prospectively obtained from patients diagnosed with myelopathy between February 2006 and April 2009. Inclusion criteria included 1) the presence of an intramedullary T2-high signal intensity and 2) a final diagnosis of idiopathic ATM or SCI established by one neurologist. In total, 13 patients (M : F = 8 : 5; mean age, 39.5 years; range, 29-50 years) with idiopathic ATM and seven patients (M : F = 2 : 5; mean age, 58 years; range, 48-75 years) with SCI were included in this study. Two radiologists evaluated the DWIs and ADC map in consensus. The extent of the cord signal change was also evaluated on T2-weighted sagittal images. Results: Among the 16 patients with ATM, 14 patients showed iso-signal on an ADC map, but one case showed restricted diffusion and another showed increased diffusion on the ADC map. Among the seven patients with SCI, five patients showed restricted diffusion. Conclusion: Idiopathic ATM usually does not demonstrate restricted diffusion, which can be a clue to differentiate it from SCI. However, idiopathic ATM with larger segment involvement can show focal diffusion restriction.

목적: 특발성 급성 횡단성 척수염과 급성 척수 경색의 확산 강조 MR 소견을 비교한다. 대상과 방법: 2006년 2월부터 2009년 4월까지 급성 척수기능이상을 보인 환자들에서 확산 강조 영상과 확산 계수 지도를 획득하였다. 연구 포함 기준은 1) 최종 임상 진단에서 특발성 급성 횡단성 척수염이나 급성 척수 경색으로 진단된 환자이며 2) T2강조영상에서 척수내 고신호강도 병변이 있는 경우로 하였다. 최종적으로 13명의 특발성 급성 횡단성 척수염과 7명의 급성 척수 경색 환자가 포함되었다. 두 명의 영상의학과 의사가 확산 강조 영상과 확산 계수 지도를 평가하였고, 시상면의 T2 강조영상에서 척수병변의 범위를 측정하였다. 결과: 13명의 특발성 급성 횡단성 척수염 환자 중 11예(85%)는 확산영상에서 이상신호를 보이지 않았다. 1예는 확산 제한을 보였고, 1예에서는 확산계수가 증가되었다. 확산영상에서 이상 소견을 보인 2예는 척추체의 길이 기준으로 2개 이상의 넓은 범위를 침범하는 경우였다. 7명의 급성 척수 경색 환자 중 5예(71%)에서 확산 제한을 보였다. 척추체의 길이 기준으로 척수 경색 환자의 침범 범위는 1개에서 5개 이상으로 다양하였다. 결론: 특발성 급성 횡단성 척수염은 대부분 확산영상에서 확산 제한을 보이지 않으며, 이 소견은 급성 척수 경색과의 감별에 도움을 줄 수 있다. 그러나 넓은 범위를 침범한 특발성 급성 횡단성 척수염에서는 확산 제한을 보일 수 있다.

Keywords

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