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뇌동정맥기형에 대한 혈관촬영사진의 분석과 임상증상과의 상관관계

Other Titles
 Analysis of angioarchitecture of brain arteriovenous malformation and clinico-angioarchitectural correlation 
Authors
 유영훈 
Department
 Dept. of Nuclear Medicine (핵의학교실) 
Issue Date
1993
Description
의학과/석사
Abstract
[한글]

뇌동정맥기형은 약 50%의 환자에서 출혈이 주증상으로 발현하게 되고 출혈의 위험성은 해마다 2-4% 정도로 알려져 있다. 그리고 뇌출혈은 뇌동정맥기형 환자에 있어 심각한 이환율과 영구적인 신경학적 결손 등을 초래할 수 있고 상당한 정도의 사망율을 동반하게 되어 출혈이 예상되는 환자에 있어서 출혈의 위험 인자를 예견하고 적절한 시기에 적극적인 치료를 하여 주는 것이 중요하다. 이에 저자는 뇌동정맥기형의 혈관촬영 소견을 분석하여 출혈이나 다른 간질등의 비출혈성 임상 증상과의 상관관계를 알아보고 이러한 소견들을 통하여 출혈을 예측 할 수 있는 인자들이 있는 지에 대하여 분석하였다.

1988년 7월부터 1993년 5월까지 뇌동정맥기형으로 진단된 환자중 뇌혈관촬영, 전산화단층촬영(CT) 및 자기공명영상촬영(MRI)등 기록을 확인할 수 있었던 총 85명의 환자를 대상으로 하였다. 모든 환자에 있어 환자의 연령, 성별, 내원 당시의 증상 등을 병력 기록을 통하여 검토하였고, 뇌혈관촬영 소견 중 17가지 특성에 대하여 조사하였다. 먼저 뇌동정맥기형의 국소적 분석(topographic analysis)을 위하여 전산화단층촬영이나 자기공명영상상에서 병변 핵의 위치와 뇌혈관촬영상 섭식동맥과 유출정맥에 따라서 6가지 유형으로 나

누어 보았고, 혈관촬영상의 구조적인 특성은 각각 섭식동맥, 핵 및 유출정맥으로 나누어 분석하여 다음과 같은 결과를 얻었다.

1. 성별은 1.23:1로 남자에서 약간 더 많았고, 연령 분포는 10서에서 40세까지가 많았으며, 20대에서 32.9%로 가장 많았다.

2. 내원 당시의 임상증상은 출혈에 의한 증상이 65.9%로 가장 많았고, 비출혈성 증상으로는 간질이 28.2%로 많았다.

3. 뇌동정맥기형의 국소적 분포는 피질-피질하형이 49.4%로 가장 많았고 각각 출혈군과 비출혈군간의 비교에서는 피질-뇌량형과 심재형이 출혈과 연관성이 높았다.(p<0.05)

4. 섭식동맥의 수화 공급 유형의 분석에서 3개 이상 섭식동맥의 공급을 받는 경우가 41.2%로 가장 많았고, 섭식동맥의 직접공급만 받는 경우가 55.3%로 가장 많았으나 출혈군과 비출혈군에 있어서 통계학적으로 유의한 차이는 없었다.

5. 섭식동맥의 국소적 협착은 8.3%에서 관찰되었는데 출혈 환자군에서보다 비출혈 환자군에서 좀 더 빈번히 관찰되었고, 섭식동맥의 동맥류는 15.3%에서 관찰되었고, 출혈 환자군에서 좀 더 빈번히 관찰되었으나 출혈군과 비출혈군간의 통계학적으로 유의한 차이는 없었다. 혈관종형(angiomatous)변화는 15.3%의 환자에서 관찰되었고 비출혈군에서 더 많이 관찰되었지만 두 군 간의 통계학적 차이는 경계선 상에 있었다. 경막동맥을 통한 동맥 공급은 14.1%에서 관찰되었는데 비출혈군에서 더 많이 나타났다.(p<0.05)

6. 핵의 크기는 2cm 이하가 44.7%로 가장 많았고, 핵의 크기가 작은 경우는 출혈군에서, 큰 경우는 비출혈군에서 각각 빈번히 관찰되었고(P<0.05), 핵내외 맹낭은 15.3%에서 나타났는데 출혈군에서 더 많았다.(p<0.05)

7. 유출정맥의 수는 1개의 유출정맥만을 갖는 경우가 60.0%로 가장 많았고, 1개 또는 2개인 경우는 출혈군에서 더 많이 관찰된 반면, 3개 이상인 경우는 비출혈군에서 유의하게 더 많이 보였고, 유출정맥 형태는 얕은정맥으로의 유출만을 보인 예가 70.6%로 제일 많

았고, 깊은정맥으로만 정맥유출을 보인 예는 출혈군에서 더 많이 관찰되었다. (p<0.05)

8. 유출정맥의 협착과 정맥류는 각각 47.1%와 27.1%에서 관찰되었는데, 출혈군에서 더 많이 관찰되었고(p<0.05), 유출정맥의 비정상적 확장이나 혈전 또는 꼬임은 각각 27.1% 및 5.4%, 29.4%에서 관찰되었는데 세 경우 모두 출혈군과 비출혈군간의 통계학적으로 유

의한 차이는 관찰되지 않았다. 혈관찰영상 정맥성 고혈압은 15.3%에서 동반되었는데 비출혈환자군에서 더 많이 관찰되었다.(p<0.05)

이상을 통하여 뇌동정맥기형의 국소적 위치와 맥관구조적 특성에 대한 분석으로 출혈은 심재형, 피질-뇌량형, 핵의 크기가 작을때, 핵내외 맹낭, 유출 정맥이 하나이거나 깊은 정맥으로만 유출될 때, 유출정맥의 협찰이나 정맥류가 있을 때에 통계학적으로 유의한 연

관성이 관찰되었고, 간질등 비출혈성 증상의 경우 핵의 크기가 큰 경우, 경막 동맥을 통한 곰곰이 있는 경우와 정맥성 고혈압이 있는 경우가 상관관계가 있음을 알 수 있었다.

이러한 인자들의 분석을 통하여 뇌동정맥기형의 치료방향 결정이나 예후를 파마하는데 도움이 될 수 있을 것으로 생각한다.





Analysis of angioarchitecture of brain arteriovenous malformation and clinico-

angioarchitectural correlation



Young Hoon Ryu

Department of Medical Science The Graduate School, Yonsei University

(Directed by Assistant Professor Dong Ik Kim)



Approximately 50% of patients with brain arteriovenous malformations present

symptoms of hemorrhage and the risk of initial hemorrhage is approximately 2∼4%

per year. Intracranial bleeding represents the most devasting complication of brain

arteriovenous malformations. It produces significant morbidity, often in the form

of a permanent neurologic deficit and a considerable risk of mortality. Therefore

it is important to identify the subgroup of patients most likely to develop

bleeding. These patients should be expected to derive greater benefit from

therapaeutic intervention than those who may not bleed

This research systematically analyzed angioarchitecture of arterievenous

malformations in order to clarify the angiographic risk factors for intracerbral

hemorrhage.

From July 1988 to May 1993, 85 patients who underwent cerebral angiography and

diagnosed as brain arteriovenous malformations were included in this study.

Retrospective review of clinical history and angiography wore done. Topographic

analysis and evaluation of 17 angioarchitectural characteristics were conducted and

the following results were obtained.

1. The ratio of males to females was 47:38 arts the third decade was the most

common.

2. Hemorrhage was the most frequent (65.9%) clinical manifestations and seizure

was most common in patients who present with nonhemorrhagic symptoms.

3. In the topographic analysis, cortico-subcortical type was most commanly seen,

and deep-seated type and cortico-callosal type were significantly frequent in the

hemorrhagic group.

4. Arterial supply by more than 3 feeding arteries arts only direct arterial

feeding were common findings, but there is no significant correlation between

hemorrhagic and nonhemorrhagic group.

5. Stenosis of feeding artery and angiomatous changes were more frequent in the

nonhemorrhagic group and aneurysm of feeding artery was more frequent in the

hemorrhagic group, though they were not statistically significant.

6. Smaller sized nidus tends to bleed, but larger one tends to show

nonhemorrhagic symptoms.

7. In view of venous drainage route fewer number(1 or 2) and only deep venous

drainage were significantly correlated with hemorrhagic symptoms.

8. Venous stenosis and aneurysm were statistically significantly frequent in the

hemorrhagic group and venous hypertension was significantly frequent in the

nonhemorrhagic group. Venous ectasia, kinking and thrombosis were not significantly

different between hemorrhagic and nonhemorrhagic groups.

In conclusion, deep-seated and cortico-callosal type, small nidus size intranidal

pouch, 1 draining vein deep venous drainage only, venous stenosis and venous

aneurysm were the most discriminating or predictive characteristics of hemorrhage

in brain arteriovenous malformation. And large nidus size, dural supply and venous

hypertension were correlated with nonhemorrhagic symptoms such as seizure, headache

and neurologic deficit Therefore a detained analysis of the angioarchitecture of

brain arteriovenous malformations helped identify features that strongly correlated

with prognostic implications for the treatment of patients with these lesions.

[영문]

Approximately 50% of patients with brain arteriovenous malformations present symptoms of hemorrhage and the risk of initial hemorrhage is approximately 2∼4% per year. Intracranial bleeding represents the most devasting complication of brain

arteriovenous malformations. It produces significant morbidity, often in the form of a permanent neurologic deficit and a considerable risk of mortality. Therefore it is important to identify the subgroup of patients most likely to develop

bleeding. These patients should be expected to derive greater benefit from therapaeutic intervention than those who may not bleed

This research systematically analyzed angioarchitecture of arterievenous malformations in order to clarify the angiographic risk factors for intracerbral hemorrhage.

From July 1988 to May 1993, 85 patients who underwent cerebral angiography and diagnosed as brain arteriovenous malformations were included in this study.

Retrospective review of clinical history and angiography wore done. Topographic analysis and evaluation of 17 angioarchitectural characteristics were conducted and

the following results were obtained.

1. The ratio of males to females was 47:38 arts the third decade was the most common.

2. Hemorrhage was the most frequent (65.9%) clinical manifestations and seizure was most common in patients who present with nonhemorrhagic symptoms.

3. In the topographic analysis, cortico-subcortical type was most commanly seen, and deep-seated type and cortico-callosal type were significantly frequent in the hemorrhagic group.

4. Arterial supply by more than 3 feeding arteries arts only direct arterial feeding were common findings, but there is no significant correlation between hemorrhagic and nonhemorrhagic group.

5. Stenosis of feeding artery and angiomatous changes were more frequent in the nonhemorrhagic group and aneurysm of feeding artery was more frequent in the hemorrhagic group, though they were not statistically significant.

6. Smaller sized nidus tends to bleed, but larger one tends to show nonhemorrhagic symptoms.

7. In view of venous drainage route fewer number(1 or 2) and only deep venous drainage were significantly correlated with hemorrhagic symptoms.

8. Venous stenosis and aneurysm were statistically significantly frequent in the hemorrhagic group and venous hypertension was significantly frequent in the nonhemorrhagic group. Venous ectasia, kinking and thrombosis were not significantly different between hemorrhagic and nonhemorrhagic groups.

In conclusion, deep-seated and cortico-callosal type, small nidus size intranidal pouch, 1 draining vein deep venous drainage only, venous stenosis and venous aneurysm were the most discriminating or predictive characteristics of hemorrhage

in brain arteriovenous malformation. And large nidus size, dural supply and venous hypertension were correlated with nonhemorrhagic symptoms such as seizure, headache and neurologic deficit Therefore a detained analysis of the angioarchitecture of

brain arteriovenous malformations helped identify features that strongly correlated with prognostic implications for the treatment of patients with these lesions.
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https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000004690
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 2. Thesis
Yonsei Authors
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/117546
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