척수종양의 방사선학적 고찰

Abstract

[한글]

척수종양은 60-85%가 양성종양이며, 척수와 척수신경에 미치는 압력으로 인한 불가역성 손상이 오기 전에 수술을 하면 치유될 수 있으므로 조기진단이 요구되어진다. 척수종양의 방사선학적 진단에는 단순척추촬영상, 척수조영촬영상, 그외 동위원소나 조영제를 이

용한 혈관조영술 등 여러 방법이 있다. 척수조영술로 정확히 종양의 위치를 알 수 있음을 이미 1934년에 Camp가 주장한 바 있으며, Traub(1972)에 의하면 척수조영술로는 종양의 정확한 정위를 하는 것 외에도 그외의 병소로 추간원판탈출증이나 지망막염의 병존, 다발

종양의 유무를 찾을 수 있다. 척수종양을 혈관조영술로 처음 진단한 것은 1957년 DiChiro가 혈관아세포종을 진단한 것이며, 예전에는 척수종양중 혈관종 외에는 혈관조영술이 도움이 되지 않는다고 하였으나 Herdt등 (1972)은 다혈관 척수 종양에서 수내종양과 수외종

양의 감별점을 제시하며 조직학적 진단도 어느 정도는 가능하다고 하였다.

저자는 병리조직학적으로 확진된 척수종양 108례를 대상으로 임상고찰 및 병리학적 빈도 등을 조사하였고, 특히 방사선학적 소견의 분석에 관심을 두고 86례의 단순척추촬영상 및 척수조영촬영상을 검토하였다. 그외 5례의 혈관조영상도 관찰하였으며, 이상의 사진

상의 소견으로 종양의 정확한 정위 및 조직학적 진단까지도 시도하였으며 그 결과는 다음과 같다.

1. 환자의 연령은 30대와 40대가 가장 많아서 59%를 차지하였고 남자가 더 많았다.

2. 주증상은 동통과 운동 및 지각장애였고 증상의 발전기간은 평균 17개월이었다.

3. 척수액의 단백질양은 93.3%에서 50mg% 이상으로 증가되었고, Queckenstedt 검사 결과 80%에서 양성을 나타냈다.

4. 종양의 발생부위는 흉수가 48례(44.4%)로 가장 많았고 경막내수외종양이 53례(49.7%)로 경막외종양보다(38.9%) 조금 많았다. 경막내수외종양에서는 신경섬유종, 경막외종양에서는 전이성암, 수내종양에서는 성상세포종이 제일 많았다.

5. 단순척추촬영상의 변화는 38례(44.1%)에서 나타났고 그 중 21례는 경막외종양이었으며 가장 흔한 소견은 육경의 침식으로 28례(73.7%)에서 관찰되었다.

6. 척수조영촬영상에서 경막외종양의 특징은 조영제주와 척추경과의 간격이 멀어지는 것과(75.5%) 톱니모양의 횡측결손상(54.1%)을 들 수 있다. 경막내수외종양에서는 대부분에서 척수의 변위(67.6%), 경계가 분명한 원형의 결손상(81%), 조영제주와 척추경과의 간격의 근소(70.3%)등을 나타냈다. 수내종양은 척수횡경의 팽창과(75%) 상외측으로 분기되는 조영제(75%)를 나타냈다.

7. 선택적 척수 혈관조영촬영상에서 3례의 동정맥기형은 비정상적인 사행성의 동맥이 주소견이었고 1례의 전이성암에서는 이상신생혈관을 볼 수 있었다.

RADIOLOGICAL MANIFESTION OF SPINAL CORD TUMOR

On Koo Cho

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Byung Sook Choi, M.D., Chang Yun Park, M.D.)

Since 60-85% of spinal cord tumors are benign and potentially curable when

surgery was done before irreversible pressure changes have occurred in the cord and

nerves, early diagnosis of spinal cord tumor is very important.

There are many radiological diagnostic methods such as plain film, myelogram and

angiogram using either contrast media or radioisotope. High reliability of precise

myelographic localization of spinal cord tumor has been stressed by camp (1934),

and Traub (1972) said that myelogram can furnish the information not only about the

exact tumor localization but the presence of other lesions such as disk or

arachnoiditis and existence of multiple tumors.

DiChoro(1957) described angiographic findings of hemangioblastoma and that was

the initial attempt of angiography for the spinal cord tumor diagnosis. Previously

they said that angiogram is not useful in spinal cord tumor except arteriovenous

malformation, however, Herdt et. al. (1972) reported angiographic criteria for

differentiation of intra and extramedullary vascular tumor.

This paper is a study of confirmed 108 cases of spinal cord tumor in respect to

clinical features and pathologic findings. In this analysis, special attention was

given to the 86 plain film and myelogram for differentiation of exact tumor

localization in relation to spinal cord and dura. 5 cases of angiography was

reviewed.

The results are:

1. 59% of patients were in the fourth and fifth decade and occured more

frequently in the male.

2. Patient's chief complaint was pain with motor and sensory change. Mean average

duration of symptoms was 17 months.

3. 56 of 60 cases (93.3%) show spinal fluid protein level above 50mg%.

Quechenstedt test was positive in 80% of Patient with Partial or complete

obstruction.

4. Intradural extramedullary tumors are more frequent (53 cases, 49.7%) than

extradural tumor (42 case, 38.9%) and thoracic spine was the most frequently

involved site (44.4%).

5. Benign tumors were 72 cases (66.7%) that is double incidence of malignant

tumor. Most frequent tumor was neurofibroma (54 case) that occurs at any site,

however majorities were intradural extramedullary tumor. Metastatic carcinoma was

most common tumor of extradural lesion (30.2%) and astrocytoma (36.4%) of

intramedullary lesion.

6. 38 of 86 cases (44.1%) show bone changes on plain films of spine and among

them extradural tumor was 21 cases. Most common findings of plain film change was

pedicle erosion that was noted on 28 cases (73.7%).

7. Myelographic observations in the extradural tumor show displacement of the

opaque column from the inner aspect of the bony spinal canal (75.5%), and other

useful sign was appearance of a transverse serrated block (54.1%). Mojority of

intradural tumors caused displacement of the spinal cord (67.6%), clearly outlined

concave defect (81%), and narrow distance from dye column to pedicle (70.3%).

Characteristic findings of intramedullary tumor was fusiform enlargement of spinal

cord (75%) and streaks of contrast medium diverging upward laterally around the

expanded mass.

8. 3 of 5 cases of angiogram were extraduaral arteriovenous malformation that

show abnormal tortuous hypertrophied vessel and 1 cases was extradural metastatic

Ca, with abnormal neovascularization.

[영문]

Since 60-85% of spinal cord tumors are benign and potentially curable when surgery was done before irreversible pressure changes have occurred in the cord and nerves, early diagnosis of spinal cord tumor is very important.

There are many radiological diagnostic methods such as plain film, myelogram and angiogram using either contrast media or radioisotope. High reliability of precise myelographic localization of spinal cord tumor has been stressed by camp (1934), and Traub (1972) said that myelogram can furnish the information not only about the exact tumor localization but the presence of other lesions such as disk or arachnoiditis and existence of multiple tumors.

DiChoro(1957) described angiographic findings of hemangioblastoma and that was the initial attempt of angiography for the spinal cord tumor diagnosis. Previously they said that angiogram is not useful in spinal cord tumor except arteriovenous

malformation, however, Herdt et. al. (1972) reported angiographic criteria for differentiation of intra and extramedullary vascular tumor.

This paper is a study of confirmed 108 cases of spinal cord tumor in respect to clinical features and pathologic findings. In this analysis, special attention was given to the 86 plain film and myelogram for differentiation of exact tumor localization in relation to spinal cord and dura. 5 cases of angiography was

reviewed.

The results are:

1. 59% of patients were in the fourth and fifth decade and occured more frequently in the male.

2. Patient's chief complaint was pain with motor and sensory change. Mean average duration of symptoms was 17 months.

3. 56 of 60 cases (93.3%) show spinal fluid protein level above 50mg%. Quechenstedt test was positive in 80% of Patient with Partial or complete obstruction.

4. Intradural extramedullary tumors are more frequent (53 cases, 49.7%) than extradural tumor (42 case, 38.9%) and thoracic spine was the most frequently involved site (44.4%).

5. Benign tumors were 72 cases (66.7%) that is double incidence of malignant tumor. Most frequent tumor was neurofibroma (54 case) that occurs at any site, however majorities were intradural extramedullary tumor. Metastatic carcinoma was most common tumor of extradural lesion (30.2%) and astrocytoma (36.4%) of intramedullary lesion.

6. 38 of 86 cases (44.1%) show bone changes on plain films of spine and among them extradural tumor was 21 cases. Most common findings of plain film change was pedicle erosion that was noted on 28 cases (73.7%).

7. Myelographic observations in the extradural tumor show displacement of the opaque column from the inner aspect of the bony spinal canal (75.5%), and other useful sign was appearance of a transverse serrated block (54.1%). Mojority of intradural tumors caused displacement of the spinal cord (67.6%), clearly outlined concave defect (81%), and narrow distance from dye column to pedicle (70.3%).

Characteristic findings of intramedullary tumor was fusiform enlargement of spinal cord (75%) and streaks of contrast medium diverging upward laterally around the expanded mass.

8. 3 of 5 cases of angiogram were extraduaral arteriovenous malformation that show abnormal tortuous hypertrophied vessel and 1 cases was extradural metastatic Ca, with abnormal neovascularization.