악성 고립성 폐결절: 역동적 조영증강 전산화단층촬영에서의 조영증강 형태와 조직병리 소견에 관한 연구 = Malignant Solitary Pulmonary Nodule: Enhancement Patterns on Contrast-enhanced Dynamic CT with the Histopathologic Evaluation

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to evaluate the potential role of dynamic incremental computed tomography (CT) for making the diagnosis of malignant solitary pulmonary nodule (SPN) by investigating the dynamic enhancement patterns.
Materials and Methods: Forty patients with presumed malignant SPN (diameter < 30 mm) were selected for dynamic incremental chest CT scanning. Histopathologic diagnoses of the malignant SPNs were obtained by surgical excision (n=8) and transthoracic needle biopsy (n=32), and they were squamous cell carcinoma (n=16), adenocarcinoma (n=14), small cell carcinoma (n=5), bronchioloalveolar carcinoma (n=3), and large cell carcinoma (n=2). CT scans were performed at the region of interest (ROI) of the lung nodule before and after contrast enhancement. The dynamic incremental CT scans after contrast enhancement were performed at 15 seconds, 30 seconds, 45 seconds, 60 seconds, 90 seconds, 2 minutes, 3 minutes and 4 minutes. The degree of contrast enhancement according to the time course and the time of maximum enhancement of the malignant nodules were recorded by measuring the Hounsfield Unit (HU) of the nodules at the ROI. We assessed the differences of the contrast enhancement patterns among the histopathologic subtypes of malignant SPN.
Results: In malignant SPN, the average time of maximum contrast enhancement was 62.2±16.2 seconds, and the average degree of maximum contrast enhancement was 66.4±22.17 HU. Most primary lung cancer showed rapid contrast enhancement with slow washout. The differences of the enhancement patterns among the histopathologic subtypes were not statistically significant (p > 0.05).
Conclusion: Dynamic incremental chest CT was useful for making the diagnosis of malignant SPN that showed an established dynamic contrast enhancement pattern regardless of the histopatholgic subtypes.

국문 초록 (Abstract)

목적: 악성 고립성 폐결절(Solitary Pulmonary Nodule, 이하 SPN)의 조영 증강 양상을 분석하여 이의 진단에서 역동적 조영 증강 흉부 전산화단층촬영(Computed Tomography, 이하 CT)의 잠재적 역할에 대하여 알아보고자 하였다.
대상과 방법: 역동적 조영증강 흉부 CT를 시행한 30 mm 미만의 악성 SPN을 가진 40명의 환자를 대상으로 하였다. 각각의 결절에 대해 수술적 절제(n = 8) 또는 경피적 세침 조직검사(n= 32)를 시행하여 병리조직학적 결과를 얻었으며, 이들의 조직병리학적 아형들은 편평상피세포암(n = 16), 선암(n = 14), 소세포암(n = 5), 세기관지폐포암(n = 3), 그리고 대세포암(n = 2) 이었다. SPN의 관심영역(region of interest, ROI)에 대해 조영전과 후에 역동적 조영증강 CT를 시행했다. 역동적 조영증강 CT는 조영제 주입 후 각각 15초, 30초, 45초, 60초, 90초, 2분, 3분, 4분에 시행하였다. SPN의 관심구역(region of interest, ROI)에서 하운스필드 수치(HU)를 측정함으로써 결절의 시간경과에 따른 조영증강 정도와 최대 조영증강에 이르는 시간을 기록했다. 각각의 악성 SPN의 조직병리학적 아형에 따른 조영증강 양상의 차이를 평가하였다.
결과: 악성 SPN의 최대 조영증강 시간의 평균은 62.2±16.2초이었고 최대 조영증강 정도의 평균은 66.42±22.17 HU이었다. 대부분의 악성 SPN은 빠른 조영증강과 함께 느린 씻음을 보였으나, 이들의 조직병리학적 아형에 따른 조영증강 형태는 통계적으로 유의한 차이를 관찰할 수 없었다(p > 0.5).
결론: 역동적 조영증강 CT는 악성 SPN의 조직병리학적 아형들 간에 차이를 보여주지는 않았지만, 조영증강 양상에 의한 이들의 진단에 유용하리라 생각한다.

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