유방 절제술 환자의 척추 측만 변화: 다중채널 전산화단층촬영을 이용한 분석 = Scoliotic Change in Patients Having Undergone a Mastectomy: Analysis Using Multi-Detector Computed Tomography

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the relationship between the degree of scoliotic curvature and postoperative change of the chest wall among patients who underwent a unilateral mastectomy.
Materials and Methods: Subjects were comprised of 56 women who underwent chest CT and a whole spine standing anteroposterior view (WSSAP). Cobb’s angle and each side of the chest wall volume, including the breast, were measured with the WSSAP and a 3-D reconstructed multi-detector computed tomography (MDCT) image. A correlation analysis was performed between the scoliotic curvature and chest wall volume asymmetry. Directional correspondence between development of scoliosis and undergoing a mastectomy was analyzed. Furthermore, a survey on patient shoulder function was performed using a questionnaire and a correlation was performed between the results of the survey and the scoliotic curvature and chest wall volume asymmetry.
Results: The findings indicate that Cobb’s angles were 4.4° ± 2.7 (Mean ± SD, range from 0.6 to 11.4). Differences in chest wall volume were 474.64 ± 276.36 cm^3 (Mean ± SD, range from 78 to 1379). No statistical significance was noted between the degree of scoliotic curvature and chest wall volume asymmetry (p > 0.05). A cross-tabulation analysis of the direction between the scoliotic curvature and mastectomy was found to be statistically significant (p < 0.001). Also, there was a significant correlation between shoulder function assessment score and the degree of scoliotic curvature (p = 0.003), while no significant correlation between shoulder function assessment score and chest wall volume asymmetry (p = 0.091) could be found.
Conclusion: Scoliotic change had a tendency to be on the opposite side of the mastectomy and had no statistically significant relationship with the volume asymmetry. Thus, 3-D reconstructed MDCT images are helpful in differentiating selective volume differences.

국문 초록 (Abstract)

목적: 유방 절제술을 시행한 환자들에서 유방을 포함한 양측 흉벽의 변화와 척추의 측만곡 변화의 관계를 알아보고자 하였다.
대상과 방법: 대상은 유방암으로 일측유방절제술을 받은 후 흉부 CT로 추적관찰을 시행하던 환자 중, 전척추기립전후촬영을 시행한 56명의 여성 환자였다. 척추 측만곡의 정도를 평가하기 위해 Cobb’s angle을 측정하고 양측의 유방을 포함한 흉벽 조직의 부피를 3차원 재구성 multi-detector CT (이하 MDCT) 영상을 이용하여 측정하였다. 측만 변화와 양측 흉벽 부피의 차이 간의 상관분석을 하였고, 수술 방향에 따른 측만곡 진행 방향에 대한 교차분석을 시행하였다. 또한 어깨 관절 기능 평가를 위한 설문조사를 하여, 측만 변화와 양측 흉벽 부피 차이와의 상관분석을 각각 시행하였다.
결과: 56명의 환자에서 측만 변화는 평균 4.4°± 2.7(범위: 0.6~11.4)이었고, 유방을 포함한 양측 흉벽 부피의 차이는 평균 474.64 cm^3 ± 276.36(범위: 78~1,379)이었다. 측만 변화와 유방을 포함한 양측 흉벽 부피의 비대칭 정도 간의 상관분석에서는 통계학적인 유의성이 없었으나(p ＞ 0.05), 수술 방향에 따른 측만곡은 서로 반대방향으로 나타나는 경향을 보이며 통계적으로 유의한 차이가 있었다(p ＜ 0.001). 어깨 관절 기능 평가 점수는 측만 변화와 유의한 상관관계가 있었으나(p = 0.003), 양측 흉벽 부피 차이와는 유의한 상관관계가 없었다(p = 0.091).
결론: 일측 유방절제술 후 측만 변화는 수술 부위의 반대측에 나타나는 경향을 보였고, 좌우 유방 및 흉벽 부피의 차이와는 유의한 상관관계를 보이지 않았다. 또한, 흉벽 부피 측정에 사용된 3차원 재구성 MDCT 영상은 선택적인 조직의 부피 측정에 유용하다.

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