Investigative Magnetic Resonance Imaging

  • 제18권4호
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  • Pages.323-331
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  • 2014
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  • 2384-1095(pISSN)
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  • 2384-1109(eISSN)
대한자기공명의과학회 (Korean Society of Magnetic Resonance in Medicine)
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하부직장암 환자에서 초음파겔 삽입 전후의 골반 자기공명영상의 비교

Preoperative Evaluation of Lower Rectal Cancer by Pelvic MR with and without Gel Filling

  • 김대중 (연세대학교 강남세브란스병원 영상의학과) ;
  • 김주희 (연세대학교 강남세브란스병원 영상의학과) ;
  • 임준석 (연세대학교 세브란스병원 영상의학과) ;
  • 정재준 (연세대학교 강남세브란스병원 영상의학과) ;
  • 유정식 (연세대학교 강남세브란스병원 영상의학과) ;
  • 김명진 (연세대학교 세브란스병원 영상의학과) ;
  • 김기황 (연세대학교 세브란스병원 영상의학과)
  • Kim, Dae Jung (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Joo Hee (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lim, Joon Seok (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Chung, Jae-Joon (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yu, Jeong-Sik (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Myeong-Jin (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Ki Whang (Department of Radiology, Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2014.10.04
  • 심사 : 2014.11.18
  • 발행 : 2014.12.31
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초록

목적: 하부직장암 환자에서 수술 전 평가를 위한 골반 자기공명영상에서 직장 내 초음파 겔 삽입 효과를 알아보고자 하였다. 대상과 방법: 2008년 9월부터 2009년 2월까지 하부직장암 환자 25명을 대상으로 하였으며 이들은 모두 수술 전 골반 자기공명영상을 시행하였으며 직장 내 초음파 겔 삽입 전후로 하여 두 차례 시행하였다. 두 명의 영상의학과 의사가 독립적으로 그리고 후향적으로 각 환자의 두 번의 골반 자기공명영상에서 항문 조임근 침범, 절제 범위 침범, 그리고 종양 묘사에 대하여 분석하여 각 항목에 대하여 5단계로 점수를 기록하였다. 그리고 위 두 명의 영상의학과 의사가 합동으로 각 환자의 두 번의 골반 자기공명영상을 바탕으로 항문 피부선에서 종양까지의 거리와 종양의 T항목과 N항목의 병기를 후향적으로 분석하였으며 내시경상 길이와 조직학적 병기를 기준으로 하였다. 결과: 초음파 겔을 삽입한 골반 자기공명영상이 종양 묘사 점수가 통계학적으로 유의하게 높았다 (p < 0.001). 항문 조임근 침범과 절제범위 침범의 점수는 두 검사간 통계학적으로 유의하게 차이가 있지 않았다 (p > 0.05). 항문 피부선에서 종양까지의 거리는 초음파 겔을 삽입한 골반 자기공명영상이 내시경과 통계학적으로 유의하게 차이가 있었다 ( $6.8{\pm}1.6cm$ vs. $5.8{\pm}1.6cm$, p=0.001). 병리적 병기를 기준으로 두 검사간의 영상의학적 병기는 통계학적으로 유의하게 차이가 있지 않았다. 결론: 초음파 겔을 이용한 골반 자기공명영상은 젤을 이용하지 않는 골반 자기공명영상에 비하여 종양 묘사를 향상시키며 또한 항문 조임근 침범과 절제범위 침범 판단에 같은 능력을 보여 주었다.

Purpose : To assess the usefulness of rectal filling using ultrasonographic gel in patients with lower rectal cancer. Materials and Methods: Twenty five patients with lower rectal cancer were enrolled. High resolution pelvic MR was performed twice before and after gel filling. Independently and retrospectively, two radiologists reviewed each set of MR images using five-grade scales for sphincter involvement, CRM (circumferential resection margin) involvement and depiction of the tumor. Same two radiologists retrospectively performed consensus review of each set of MR images for tumor distance from the anal verge and T&N staging. Results: Tumor depiction scores from MR with gel filling were significantly higher than those of MR without distention (p<0.001). Compared to MR without distension, MR with gel filling had no significant differences in prediction of CRM or sphincter involvement (p>0.05). Distance from the anal verge was significantly different between MR with gel filling and rigid endoscopy ($6.8{\pm}1.6cm$ vs. $5.8{\pm}1.6cm$, p=0.001). There were no significant differences between pathological staging and MR staging with or without gel filling. Conclusion: MR with gel filling improved tumor depiction. And also MR with gel filling revealed same ability for the predictions of CRM or sphincter invasion in patients with lower rectal cancer, comparing with MR without gel filling.

키워드

참고문헌

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피인용 문헌

  1. Radiologic Report for Magnetic Resonance Imaging of Rectal Cancer before Treatment vol.80, pp.3, 2014, https://doi.org/10.3348/jksr.2019.80.3.425