대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제84권5호
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  • Pages.1066-1079
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  • 2023
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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경막내 척수외 뇌실막세포종의 임상 영상의학적 특징

Clinicoradiologic Characteristics of Intradural Extramedullary Conventional Spinal Ependymoma

  • 이승현 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 차윤진 (연세대학교 의과대학 강남세브란스병원 병리과) ;
  • 조용은 (연세대학교 의과대학 강남세브란스병원 신경외과) ;
  • 박미나 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 주비오 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 서상현 (연세대학교 의과대학 강남세브란스병원 영상의학과) ;
  • 안성준 (연세대학교 의과대학 강남세브란스병원 영상의학과)
  • Seung Hyun Lee (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon Jin Cha (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yong Eun Cho (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Mina Park (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Bio Joo (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sang Hyun Suh (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sung Jun Ahn (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2022.08.24
  • 심사 : 2023.01.10
  • 발행 : 2023.09.01
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초록

목적 경막내척수외 뇌실막세포종의 임상 및 영상 특성에 대한 보고는 드물다. 하지만, 발생 위치와 병리학적 특성을 고려하였을 때 점액유두상 뇌실막세포종과 구별하기 어렵다. 본 연구는 경막내척수외 뇌실막세포종과 척수 점액유두상 뇌실막세포종을 구별하기 위한 임상적 특징 및 MRI 영상 특징을 조사하였다. 대상과 방법 종양 크기, 종양의 종축/횡축 위치, 조영 정도/패턴, 동공, 종양 변연, T2 강조 영상(T2-weighted image), T1 강조 영상(T1-weighted image; 이하 T1WI), 종양 아래의 cerebrospinal fluid (이하 CSF) T1 신호강도 증가 및 CSF space로의 종양 전파에 대하여 12개의 병리학적으로 확인된 경막내척수외 뇌실막세포종과 10개의 병리학적으로 확인된 척수 점액유두 뇌실막세포종을 대상으로 분석을 하였다. 또한, 분류 및 트리 분석(classification and tree analysis; 이하 CART) 을 수행하여 경막내척수외 척수 뇌실막세포종을 점액유두 뇌실막세포종과 구별하는 데 중요한 임상적 특징 및 MRI 영상 특징을 조사하였다. 결과 경막내척수외 뇌실막세포종 환자는 척수 점액유두 뇌실막세포종 환자보다 유의하게 나이가 많았으며(48세 vs. 29.5세, p < 0.05), T1W1에서 높은 신호 강도는 점액유두상 뇌실막세포종보다 경막내척수외 척수 뇌실막세포종에서 더 자주 관찰되었다(p = 0.02). 반대로 점액유두상 뇌실막세포종은 지주막하강으로의 종양의 파급을 보였다. CSF 신호 강도는 경막내 척수외 척수 뇌실막세포종보다 점액유두 뇌실막세포종에서 더 자주 관찰되었다(p < 0.05). 종양 아래로의 CSF T1 신호 증가 및 CSF space로의 종양 전파는 경막내척수외 척수 뇌실막세포종과 점액유두 뇌실막세포종을 구별하기 위한 CART 분석에서 가장 중요한 변수였다. 결론 경막내척수외 뇌실막세포종과 척추 점액유두 뇌실막세포종을 구별하는 데 있어 임상 및 MRI 영상의 특징이 도움이 될 수 있다.

Purpose Distinguishing intradural extramedullary (IDEM) spinal ependymoma from myxopapillary ependymoma is challenging due to the location of IDEM spinal ependymoma. This study aimed to investigate the utility of clinical and MR imaging features for differentiating between IDEM spinal and myxopapillary ependymomas. Materials and Methods We compared tumor size, longitudinal/axial location, enhancement degree/pattern, tumor margin, signal intensity (SI) of the tumor on T2-weighted images and T1-weighted image (T1WI), increased cerebrospinal fluid (CSF) SI caudal to the tumor on T1WI, and CSF dissemination of pathologically confirmed 12 IDEM spinal and 10 myxopapillary ependymomas. Furthermore, classification and regression tree (CART) was performed to identify the clinical and MR features for differentiating between IDEM spinal and myxopapillary ependymomas. Results Patients with IDEM spinal ependymomas were older than those with myxopapillary ependymomas (48 years vs. 29.5 years, p < 0.05). A high SI of the tumor on T1W1 was more frequently observed in IDEM spinal ependymomas than in myxopapillary ependymomas (p = 0.02). Conversely, myxopapillary ependymomas show CSF dissemination. Increased CSF SI caudal to the tumor on T1WI was observed more frequently in myxopapillary ependymomas than in IDEM spinal ependymomas (p < 0.05). Dissemination to the CSF space and increased CSF SI caudal to the tumor on T1WI were the most important variables in CART analysis. Conclusion Clinical and radiological variables may help differentiate between IDEM spinal and myxopapillary ependymomas.

키워드

과제정보

This work was supported by a grant from the Central Medical Service Research Fund to SJA.

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