大 파放껴 *Jl! 짧탤썩誌 Vol. xx, No. 3, 984 Z 7 흉끓홉 jfl 꺼對한 갓 ;;: 사갑 ιzf ; / 電算化斷層擬影 7 용힐熙大學校 醫科大學 放射짧科學敎室 -bstract- 崔 祐 碩 林 z 在勳 金짧鍵 시 V! i 7 g ι Computed Tomographic Evaluation of the Osseous Pelvis W.S. Choi, M.D., J.H. Li m, M.D., S.Y. Kim, M.D. Department of Radiology, Kyung Hee University Hospital, Seoul, Korea The advantages of computerized tomography in evaluation of the osseous pelvis are known. We have analyzed the CT findings of various osseous diseases in the pelvis. CT appeared to be the most efficient tool in evaluating the location and extent of the primary lesion as well as the invasion of the surroundings.,vell I 績 論. 對象및 方法 骨盤骨 찾ι뽑을 ~~ 斷하는데 있어서 從來의 X 線檢흉 法으로는單純짧影및斷層짧影뿐이고이 또한骨盤骨 의 解암 U 學的짧雜性과陽內 가스와뿔등의 重웰된像 들때문에 病變의有無와그홈犯範圍및病期를決定 하는데많은어려움이있다 2,6) 그러나 CT는그自 體 장斷能力의正確性은꺼論이고骨盤의 橫斷像이기 때문에엽 盤骨과軟部組織들의左右가 同 -한正確한 對照的 映像을보여 줌a로써 異常所見의發見이容 易하고또骨盤뾰內에는 많은 량의 R읍防이 있어各 器官들의 혈界가解明함으호骨盤骨 흉愚의 骨盤뾰內 로의 波及與否와그範圍를該斷하는데도매우有利 하다 -μ. 著者들은本 敎室에서 趣行한骨盤 CT 中手術所見 과病理組織學的 ~~ 짧yo ] 確認된협 盤뀔 病, 원3 ll{ 째를 檢討하고文敵考察과함께 報告하고자 한다. 本敎室에서施行한骨盤 CT 中 手術로써그肉眼的 所見이確認되고病理組熾學的으로確該이可能했든 骨盤骨 ~, 휠 { 히 j 플對象으로하였다 CT 擺影은愚者을 frpþi t 立로하여骨 結合으로부터始 Table I. Pathologic diagnosis of osseous pelvic lesions Diagnosis Male Female - Metastatic adenocarcinoma -ι이4tuberculous sacroiliitis i Teratoma l Chordoma Neurilemmoma Ewing s sarcoma Synovial sarcoma l Synovial chondromatosis Malignant fibrohistiocytoma Total?--i,,,------ι이논문은 84 년 7 월 9 일에 채택되었음. Tota! 7 4-577-
作해서 4mm의間隔으 로 t 方으로섬훌影하였으며檢이各各 l 例씩이었다 CTa ble I ). 흉 30 分前에 200ml 의 0 % Gastrografin 을經口投.î:ØlJ. 陣移性線찮. 59 才. 男子 CFig.l 및 ) 與하여陽內造影을하였고檢훌直前에 uscopan 約 年前부터下背痛이發生하였3며過去歷上約 ml 를節肉注射하였다. 病벚에따라 window width 를 20 年前에不全뽑切除術을받은바있다. 單純 X 線據影適宣調節해서影像을얻었으며各病벚에對한 X 線寫훨上큰異常을發見할수없고단지左測薦骨 部位吸收係數를算出하였다. 에骨破壞를疑心할수도있다그려나 CT는크고顯著한薦骨의破壞와周용접軟部組織睡塊를健明하게 m. CT 所見보여준다. f돗愚別分布는轉移性 R뽕 짧과結核性薦陽骨關節찢효例 2. Ewing 肉睡. 4 歲男子 CFig.2 및 ) 이各各 2 例이었고, 뼈形睡, 神經繼維睡, 좁索睡, 隔體肉陣 Ewing 肉睡, 띔題軟骨睡 [, 惡住鐵維組織球睡 Fig.. Metastatic adenocarcinoma.. The corwentional -P view of the pelvis reveals no evidence of gross abnormality, except a questionable area of decreased density in left sacrum.. CT of sacrum at the level of Sl shows marked destruction of the sacrum, mainy left side, with soft tissue bulging.? 뺀.. 빼 IIL. 월혔뿔톨. Fig. 2. Ewing s sarcoma. -P view of the pelvis reveals marked osteolytic destruction of lower sacrum. The CT through the level of S4 shows amost complete destruction of sacrum, but normal sacroiliac joints. Extension of pathology to the left Gluteus medius and piriformis musces are well delineated. The urinary bladder and rectum are displaced by the presacral mass 578 -
約 2 個月前부터 ij(}}j( 빚排使困離이發生하였다. 單純 X 線짧彩寫밍- 上下部 j젤합의廣範떠한破製가보일뿐이다그이나 CT J: 廣範댐한薦셉 의破壞뭔아니라同伴된中뺨節과찢狀 8져 로의홉犯과路 ljj't 및 同 { 半되었다. 單純 X 線振影寫質上薦骨下部와尾 / 움 의甚한합破짧가보인다 CT 上廣範圍한 j웰骨破壞와함께軟部組織睡塊가薦骨의前後部로波及되어있음을올수있다. 直陽의해 j 方첼 { 立플明 lìæ 하게證明할수있다. 'ile ØJJ 3. 홉索햄. 50 歲男子 (Fig.3 및 ) 'ileøjj 4. 結核 ti 薦陽骨關節찢, 22 歲 및 ) 女子 ~Fig.4 約 6 個月前부터下背部에陣塊가觸知되고鏡痛이約 5 個月前부터右測聲部에鏡痛이있었다. 單 Fig. 3. Chordoma. -P view of the pelvis reveals marked destruction of lower sacrum and coccyx. The marked distension of uri.nary bladder is due to incontinencc.. CT through the level of 55 shows complete destruction of sacrum with lobulate presacral mass. The fat planes between both Gluteus maximus musces and sacrum are welj preserved. Fig. 4. Tuberculous sacroilütis. -P view of the pelvis reveals irregular destruction of the right sacroiliac joint. There is a smalj area of questionable low density at the left iliac bone, iliopectineal line area.. CT through the level of 53 shows marked destruction of right sacroiliac joint with large heterogeneous soft tissue mass density due to abscess. sharply defined cystic destruction is noted at the left iliac bone. - 579-
_ 얹 f 엉 ------ 륙듀도 Fig. 5. Teratoma.. -P view of the pelvis reveals a large soft tissue mass with band-like calcific density of its margin in the lower pelvis. There is a bony bar extending from right pubic ramus to lower margin of right sacroiliac joint area.. CT throl.!gh the level of S5 shows a large mass containing several tissue characters, such as fat, muscle and bone in the right pelvic cavity. The rectum and urinary bladder are displaced by the mass. 純 X 線振影寫휩上 右薦陽骨關節下部에 骨破壞가보이 고, 左測 陽骨에 骨破壞를疑心케 하는작은病벚가 보인다 CT 上右떼 薦陽骨關節의 甚한破평와이에 同伴된 R 農場 ~ 로因한軟 組織睡塊가證明된다. 同時에 境界가健明한左삐陽骨의 짧樣破壞가아주蘇明하게 보인다. 'ÆØlJ 5. 略形睡. 6 才 女子 ( Fig. 5 및 ) 出生 直後부터 右測뽑部에 睡塊가觸知되어왔으며 最近에는이 睡塊가成 의 주먹크기로자라났다. 單純 X 線握影寫훨上 下部骨盤脫內에 軟組織睡塊가보 이고同時에 骨樣陰影들이 觀察된다 CT 上變界가 明確한 6읍助, ílí 肉 및 骨組織等으로混成된 R휩塊가觀 察되고勝뼈과直陽等이睡뼈에 依해서變位되었음을 알수있다. 輕移病뽕는찾아볼수없으며. 良性略形 陣임을쉽게 장斷할수있었다. N. 考察 骨盤骨과이들이樞成하는없節들의病했을該斷함에있어 } 般 X 線檢훌法만 즈로는骨盤骨自體들의解 )}Ij 學的構造의複雜性뿐아니라骨盤脫內內容物의重암, 周圍軟部組織의重짧等으로因해서그明確한 등? 斷이어려운펄遇가많다. 그反面 CT 는그自體가病變의談斷能力이높을뿐아니라橫斷像이기때문에, 左右가正確히同一하고對照的이어서적은짧化도쉽게찾을수있고, 또骨盤內의뿔富한 R읍防이各職器냐組짧들의형界를解明하게그리냄으후써病變의波及與否와그範圍도容易하게!F! 徒할수 있는利點이있다 - t 7, 0) 'f:ltß로폈骨은그體部의짧은長輪에比해서너무햄曲과背面碩씹가크고前後짧이좁을뿐아니라, 陽內容物과周圍軟部組織들의重훨S로因해서單純 X 線擬影寫륨만으로는正確한評價가어려운것이事합이다. 特히後內測陽骨과前外뼈薦骨의重펠은病變의有無와그部位를判定하는데있어큰어려웅의原因이될뿐아니라, 薦陽骨閒節의 項칩진方向과起 f;i(: 面等은이部位에對한單純 X 線짧影에依한該斷을一層더어렵게한다. 또한前많骨面表面의破壞는그 a 面때문에 CT로써만이判定이可能하고, 陽骨날개는 S 字狀의兩 I!!l 面이고周짧部보다도中心部가더욱앓아서單純 X 綠擺影寫협上으j료各部分別變化 를評價하기가어려우나 CT 는쉽게그內外面과周圍節肉등을區別判斷할수있다 2) 또 Mcleod 6) 等에따르연 CT 는이미切除한骨題傷의再發과뺑移를談斷하는데 f틀越하며, 大部分의 - 580-
再發이軟部組織內에發生하기때문에單純 X 線嚴影은 거의價 ( 直가없다고報告하였다. v. 結論 本敎室에서施行한骨盤骨特히薦骨에對한手術 結果그肉眼的所見이確認되고病理組織學的으흐確 該된 例의 CT 所見을檢討한結果 CT 는骨盤骨 훌愚의有無, 病變의훔犯部位와程度. 그리고周圍軟 部組織으로의波及與否를談斷하는데있어서가장짧 秀한셜斷方法임을알수있었다. REFERENCES Radiology 727: 777-775, 7978 5. McLeod R, Gisvold J J, Stephens DH et al : Computed tomography ot soft tissues and breast. Semin Roentgenol 73:267-775, 7978 6. McLeod R, Stehens DH, eabout JW et al : Computed tomography of the skeletal system. Semin Roentgenol 73:235-24ζ 7978 7. Norman D, Korbkin M, Newton TH Computed tomography 7977. Univ. of California, San Francisco, 7977, 27-37 8. desantos L, Goldstein HM, Murrary J et al Computed tomography in the evaluation of musculoskeletal neoplasms. Radiology 728:89-94, 7978 9. Schumacher TM, Genant HK, Korobkin MJ et al Computed tomography. Its use in space-occupying lesions of the musculoskeletal system. J one. 趙京植, 徐修之, 金흉짧 骨盤홈에對한電算化斷 joint Surg 60:600-607, 79 78 層據影, 大韓放射線醫學會誌 6:83-89, 980 0. Weinberger G, Levinsohn EM Computed tomo- 2. Gilula L, Murphy W, Tailor CC et al : Computer graphy in the evaluation of sarcomatous tumors tomography of the osseous pelvis. Radiology 732: of the thigh. m J Roentgenol 730: 7 5-778, 7978 707-774, 7979. Weis L, Heelan RT, Watson RC : Computed tomo- 3. Hertzanu Y, Glass R ), Mendelsohn D : Sacrococ- graphy of orthopedic tumors of the pelvis and lower cygeal chordoma in young adults. Clinical Radiology extremities. Clin Orthop 730: 254-259, 7978 34:327-329, 7983 2. Wilson JS, Korobkin MJ, Genant HK et al : Com- 4. erger PE, Kuhn J P Computer tomography of puted tomography of musculoskeletal disorders. tumors of the musculoskeletal system in children. m j Roentgenol 737 :55-67, 7978-58-