Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Differential Diagnosis of Lymphadenopathy in the Neck Spaces in a CT Perfusion Study

관류전산화단층촬영을 이용한 두경부 림프절병의 감별진단

  • Rhee, Sun-Jung (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Hong, Hyun-Sook (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Lee, Eun-Hye (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Park, Jung-Mi (Department of Nuclear Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Lee, Min-Hee (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital)
  • 이선정 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 홍현숙 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 이은혜 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 박정미 (순천향대학교 의과대학 부천병원 핵의학과학교실) ;
  • 이민희 (순천향대학교 의과대학 부천병원 영상의학과학교실)
  • Published : 2011.11.01
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Abstract

Purpose: To evaluate the CT perfusion parameters for differentiating between a benign and malignant lymphadenopathy in the neck spaces. Materials and Methods: Seventeen patients with cervical lymphadenopathy underwent perfusion CT. Perfusion parameters, including blood flow (BF), blood volume (BV), permeability index (PI), and mean transit time, were calculated at the regions of interest in the enlarged lymph nodes (LNs). The enlarged LNs were diagnosed by fine needle aspiration, surgical excision, and clinical follow-up. The LNs were classified as either reactive hyperplasia (n = 26), metastatic LNs (n = 11), or LNs of lymphoma (n = 14). Results: Significant differences were found for BF, BV, and PI among the three groups (p < 0.05). Reactive hyperplasia had a significantly higher BF than metastatic LN (p < 0.0167). The LNs of lymphoma had a significantly lower BF, BV, and PI than reactive hyperplasia (p < 0.0167). No significant difference was observed between the metastatic LNs of the head and neck cancer and LNs of lymphoma for all perfusion parameters. Conclusion: In patients with head and neck cancer, perfusion CT is not useful for differentiating between metastatic LNs and inflammatory reactive hyperplasia. However, perfusion CT can be useful for differentiating between LNs of lymphoma and reactive hyperplasia.

목적: 두경부 림프절병 환자에서 관류 CT를 이용한 양성과 악성 림프절의 차이를 알아보고자 하였다. 대상과 방법: 두경부 림프절 종대가 있었던 17명의 환자에서 관류 CT를 시행하여 커진 림프절에 관심구역을 그려 혈류(blood flow; 이하 BF), 혈용적(blood volume; 이하 BV), 투과 지수(permeability index; 이하 PI), 평균 통과시간(mean transit time; 이하 MTT)을 구하였다. 추적검사, 미세침흡인생검, 수술적 생검을 통해 진단한 뒤 양성 림프절(n = 26), 두경부암의 전이림프절(n = 11), 림프종 림프절(n = 14)군으로 나누어 관류지표 차이를 분석하였다. 결과: 세 군의 관류지표를 비교했을 때 BF, BV, PI는 유의한 차이를 보였다(p < 0.05). 양성 림프절은 두경부암의 전이림프절에 비해 BF가 유의하게 높았다(p < 0.0167). 림프종 림프절은 양성 림프절에 비해 BF, BV, PI가 유의하게 낮았다. 양성 림프절과 림프종 림프절을 비교했을 때 BF, BV, PI가 림프종 림프절에서 유의하게 낮았다(p < 0.0167). 두경부암의 전이림프절과 림프종 림프절은 모든 지표에서 유의한 차이가 없었다. 결론: 원발성 두경부암 환자에게서 경부 림프절 종대가 있을 때, 관류 CT 영상은 염증 반응에 의한 반응성 림프절 비후와 전이림프절의 감별에는 유용하지 않았다. 그러나 양성 림프절 종대와 림프종의 감별은 림프종이 더 낮은 관류지표 값을 보이므로, 관류 CT 영상이 유용하게 사용될 수 있다.

Keywords

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