자기공명영상상 자궁내막성 낭종과 출혈성 낭종의 감별

Abstract

Purpose: To differentiate endometrial cysts from hemorrhagic cysts on the basis of MR findings Materials and Methods: The MR findings of twelve patients with endometrial cysts(15 cases) and of nine patients withhemorrhagic cyst(12 cases) were retrospectively evaluated. Fourteen patients were surgically corfirmed and sevenwith hemorrhagic cysts were clinically diagnosed by resolution of the cysts during ultrasound follow up. Sixteenpatients underwent MR imaging using a 1.5T system(Magnetom Vision, Siemens, Germany), and for five patients a 2.0Tsystem(Spectro 2000, Goldstar, Korea) was used. MR images were retrospectively evaluated with respect to size andsignal intensity of the cyst, uni/multilocularity, shading, the hematocrit effect, clot.., fluid-fluid level andseptum, and thickness, signal intensity and enhancement of the cyst wall. Result: Eleven(73.3%) endometrial cystswere multilocular, but all hemorrhagic cysts were unilocular. The signal was hyperintense on both T1WI and T2WI inten(66.7%) endometrial cysts and seven(58.3%) hemorrhagic cysts. Shading was found in five(33.3%) and one(8.3%),respectively; the hematocrit effect in two(13.3%) and five(41.7%) respectively, clot in two of each type(13.3%,16.7%), and fluid-fluid level in only one hemorrhagic cyst. Septum was found only in endometrial cysts(five cases,33.3%); its signal intensity on both T1WI and T2WI was low, and on Gd-enhanced images was not enhanced. The cystwall was thick in five of each type(33.3%, 41.7%); its signal intensity was low on both T1WI and T2WI, and notenhanced on Gd-enhanced images. In eight hemorrhagic cysts, however, the cyst wall was iso to high in signalintensity on both T1WI & T2WI, and was enhanced on Gd-enhanced images. The prevalence of uni/ multilocularity,septum, and signal intensity and the presence of enhancement of the cyst wall were significantly different between the two groups(p< 0.005). Conclusion: Uni/ multilocularity, septum, and signal intensity and enhancement of thecyst wall were useful for the differentiation of endometrial from hemorrhagic cysts. Signal intensity of the cyst,shading, the hematocrit effect and clot were not helpful.

목적: 자궁내막성 낭종과 출혈성 낭종의 감별에 자기공명영상이 유용한지를 알아보고， 유용하다면 어떤 소견들이 감별점이 되는지를 알아보고자 하였다. 대상 및 방법: 조직검사나(14명) 추적 초음파 검사로(7명) 확인된 15예(12명)의 자궁내막성 낭종과 12예(9명)의 출혈성 낭종을 대상으로 하였다. 자기공명영상은 1.5T(Magne-tom Vision, Siemens, Germany, 21예)와 2.0T(Spectro 20000, Goldstar, Korea, 6예) 기기를 이용하여 전예에서 T1과 T2 강조영상을 얻었고 22예에서는 조영증강영상을 함께 얻었다. 자기공명영상에서 낭종의 크기, 단/다방성, 낭종의신호강도, 그늘짐(shading), hematocrit 효과, 혈병(clot), 액체수준(fluid-fluid level), 격막, 낭종벽의 두께와 신호강도 및 조영증강 등을 후향적으로 분석하였다. 결과: 자궁내막성 낭종은 11예(73.3%)에서 다방성이었으나 출혈성 낭종은 모두 단방성이었다. 낭종내 신호강도는 T1과 T2 강조영상에서 모두 고 신호강도가 각각 10예(66.7%)와 7예(58.3%)였다. 그늘짐은 5예(33.3%)와 1예(8.3%), hematocrit 효과는 2예(13.3 %)와 5예(41.7%), 혈병은 각각 2예(13.3%/16.7%), 액체수준은 출혈성 낭종에서만 1예(8. 3%) 관찰되었다. 격막은 자궁내막성 낭종에서만 5예(33.3%) 관찰되었고 T1 과 T2 강조영상에서 모두 저신호강도에 조영증강이 없었다. 낭종벽은 각각 5예(33.3%, 41.7%)에서 3mm 이상 두꺼웠고, 자궁내막성 낭종에서는 전예에서 T1과 T2 강조영상에서 저 신호강도에, 조영증강이 없었으나, 출혈성 낭종에서는 8예(66.7%)에서 T1과 T2 강조영상에서 모두 등/고신호강도에, 조영증강이 있었다. 단/다방성, 격막, 낭종벽의 신호강도와 조영증강 유무는 두 질환에서 통계학적으로 유의한 차이를 보였다(p<0.05). 결론: 자궁내막성 낭종과 출혈성 낭종의 감별에는 낭종의 단/다방성, 격막, 낭종벽의 신호강도와 조영증강 유무가 도움이 되었고, 낭종의 신호강도, 그늘짐, hematocrit 효과, 혈병 등은 별 도움이 되지 않았다.