척수종양의 방사선학적 고찰 = Radiological Manifestation of Spinal Cord Tumor

다국어 초록 (Multilingual Abstract)

Since 60-85% of spinal cord tumors are benign and potentially curable when surgery was done before irreversible pressure changes have occurred in the cord and nerves, early diagnosis of spinal cord tumor is very important. There are many radiological diagnostic methods such as plain film, myelogram and angiogram using either contrast media or radioisotope. High reliability of precise myelographic localization of spinal cord tumor has been stressed by Camp (1934), and Traub (1972) said that myelogram can furnish the information not only about the exact tumor localization but the presence of other lesions such as disk or arachnoiditis and existence of multiple tumors. DiChiro (1957) described angiographic findings of hemangioblastoma and that was the initial attempt of angiography for the spinal cord tumor diagnosis. Previously they said that angiogram is not useful in spinal cord tumor except arteriovenous malformation however Herdt et al (1972) reported angiographic criteria f r differentiation of intra and extramedullary vascular tumor. This paper is a study of confirmed 108 cases of spinal cord tumor in respect to clinical features and pathologic findings. In this analysis, special attention was given to the 86 plain film and myelogram for differentiation of exact tumor localization in relation to spinal cord and dura. 5 cases of angiography was reviewed. The results are: 1. 69% of patients were in the fourth and fifth decade and occured more frequently in the male. 2. Patients's chief complaint was pain with motor and sensory change. Mean average duration of symptoms was 17 months. 3. 56 of 60 cases (93.3%) show spinal fluid protein level above 50mg%. Queckenstedt test was positive in 80% of patient with partial or complete obstruction. 4. Intradural extramedullary tumors are more frequent (50 cases, 46.3%) than extradural tumors (43 cases, 39.9%) and thoracic spine was the most frequently involved site (43.5%). 5. Benign tumors were 72 cases (66.7%) th t is double incidence of malignant tumor. Most frequent tumor was neurofibroma (54 cases) that occurs at any site, however majorities were intradural extramedullary tumor. Metastatic carcinoma was most common tumor of extradural lesion (30.2%) and astrocytoma (36.4%) at intramedullary lesion. 6. 38 of 86 cases (44.1%) show bone changes on plain films of spine and among them extradural tumor was 21 cases. Most common findings of plain film change was pedicle erosion that was noted on 28 cases (73.7%). 7. Myelographic observations in the extradural tumor show displacement of the opaque column from the inner aspect of the bony spinal canal (75.5%), and other useful sign was appearance of a transverse serrated block (43.2%). Majority of intradural tumors caused displacement of the spinal cord (67.6%), clearly outlined concave defect (81%), and narrow distance from dye column to pedicle (70.3%). Characteristic findings of intramedullary tumor was fusiform enlargement of spinal cord (75%) nd streaks of contrast medium diverging upward laterally around the expanded mass. 8. 3 of 5 cases of angiogram were extradural arteriovenous malformation that show abnormal tortuous hypertrophied vessel and 1 case was extradural metastatic Ca. with abnormal neovascularization.