진행성 거대종괴성 섬유화에서 관류 CT 영상의 유용성 = Usefulness of Perfusion CT in Progressive Massive Fibrosis

국문 초록 (Abstract)

목적: 진행성 거대종괴성 섬유화의 진단에 있어서 관류 CT의 유용성에 대해 알아보고자 하였다.
대상과 방법: 진행성 거대종괴성 섬유화 환자 13명의 20개의 병변에 대하여 관류 CT 소견을 후향적으로 분석하였다. 역동적 관류 CT 영상 자료를 얻기 위해서 16열 다중 검출기 CT를 사용하였고 다중 나선식 획득방식으로 조영 전 영상과 조영제 주입 후 15초, 30초. 45초, 60초, 90초, 120초, 180초, 300초에 촬영하여 원천 영상을 얻었다. 관류 CT는 Volume map과Washout map을 구현하여 육안적 분석으로 점수를 산정하였으며 폐암 20예의 관류 CT와 비교하였다.
결과: Volume map은 20예 중 19예에서 세 명의 관찰자 모두 중 관류 또는 저 관류이었으며Washout map에서도 19예의 중간 또는 약한 washout이였다. 세 명의 관찰자간 일치도는 통계학적으로 유의하게 높은 수치를 보였다(kappa 값 >0.818, p<0.01). PMF 군은 Volume map에서의 고 관류와 Washout map에서의 강한 washout은 모두 1예(5%)씩인데 반하여 폐암 군에서는 각각 19예(95%)와 14예(70%)이었고, Chi-Square 검정 결과 두 군간에 통계학적 차이를 보였다(χ2=32.129, p<0.01).
결론: PMF에서 역동적 CT를 이용한 관류 영상(Volume map과 Washout map)은 폐암과의 감별진단에 유용한 방법이다.

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to evaluate the usefulness of perfusion CT for the diagnosis of progressive massive fibrosis.
Materials and Methods: We retrospectively analyzed the perfusion CT images of 20 lesions that showed progressive massive fibrosis in 13 patients. Using 16 channel multi-detector CT, a dynamic study was performed with the multiple spiral acquisition technique at 0 (precontrast), 15, 30, 45, 60, 90, 120, 180, and 300 seconds after contrast injection. The perfusion image was reformatted using these source images; it was scored on the volume map and washout map by visual inspection and then compared with 20 lesions of lung cancer.
Results: The volume map showed either middle or low perfusion for 19 among the 20 lesions. The washout map also showed a weak or moderate washout pattern. The kappa values (>0.818) for the inter-reader agreement reached statistical significance (p<0.01). High perfusion on the volume map was seen in 1 case (5%) in the PMF group and in 19 cases (95%) in the lung cancer group. Intense washout on the washout map was seen in 1 case (5%) in the PMF group and in 14 cases (70%) in the lung cancer group. There was a significant difference between the two groups (χ2=32.129, p<0.01).
Conclusion: Perfusion CT consisting of the volume map and washout map can be a useful method for the differential diagnosis between PMF and lung cancer.

참고문헌 (Reference)

• 1 Yi CA, "Solitarypulmonary nodules:dynamic enhanced multi-detector row CTstudy and comparisons with vascular endothelial growth factorand microvessel density" 233 : 191-199, 2004
• 2 Zhang M, "Solitary pulmonary nodules:evaluation ofblood flow patterns with dynamic CT" 205 : 471-478, 1997
• 3 Schaefer JF, "Solitary pulmonary nodules: dynamic contrast-en-hanced MR imaging-perfusion differences in malignant and benignlesions" 232 : 544-553, 2004
• 4 Stewart GN, "Researches on the circulation time in organs and onthe influences which affect it" 15 : 1-89, 1894
• 5 Schoepf UJ, "Pulmonary embolism:comprehensive diagnosis byusing electron-beam CT for detection of emboli and assessment ofpulmonary blood flow" 217 : 693-700, 2000
• 6 Sherif H, "Peripheral washout sign on contrast-enhancedMR images of the breast" 205 : 209-213, 1997
• 7 Miles KA, "Perfusion CT: a worthwhile enhance-ment?" 76 : 220-231, 2003
• 8 Kiessling F, "Perfusion CT in patients with advanced bronchial carci-nomas: a novel chance for characterization and treatment monitor-ing?" 14 : 1226-1233, 2004
• 9 Miles KA, "Perfusion CT for the assessment of tumor vascularity:which protocol?" 76 : 36-42, 2003
• 10 Matsumoto S, "MRI signal characteristics of progressive massive fibrosis in sili-cosis" 53 : 510-514, 1998
• 11 El Khoury C, "MR quantification of the washout changes inbreast tumors under preoperative chemotherapy: feasibility andpreliminary results" 184 : 1499-1504, 2005
• 12 Jung JI, "MR characteristics ofprogressive massive fibrosis" 15 : 144-150, 2000
• 13 Kim JS, "Imaging of nonmalignant occupational lungdisease" 17 : 238-260, 2002
• 14 Miles KA, "Functional computed tomography in oncology" 38 : 2079-2084, 2002
• 15 Fitzgerald J, "Effect of motion on cardiac SPECT imag-ing:recognition and motion correction" 8 : 701-706, 2001
• 16 Matsumoto S, "Diagnosis oflung cancer in a patient with pneumoconiosis and progressivemassive fibrosis using MRI" 8 : 615-617, 1998
• 17 Screaton NJ, "Detection of lung perfusion abnormalities usingcomputed tomography in a porcine model of pulmonary em-bolism" 18 : 14-20, 2003
• 18 Hoeffner EG, "Cerebral perfusion CT:technique and clinical applications" 231 : 632-644, 2004
• 19 Axel L, "Cerebral blood flow determination by rapid sequence com-puted tomography:a theoretical analysis" 137 : 679-686, 1980
• 20 Chung MJ, "CT perfu-sion image of the lung:value in the detection of pulmonary em-bolism in a porcine model" 39 : 633-640, 2004
• 21 Bergin CJ, "CT in silicosis:cor-relation with plain films and pulmonary function test" 146 : 477-483, 1986