Original Article pissn J Korean Soc Radiol 2011;65(2): Multi-Detector CT Findings of the Normal Appendix in Children: Evaluation of t

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1 Original Article pissn J Korean Soc Radiol 2011;65(2): Multi-Detector CT Findings of the Normal Appendix in Children: Evaluation of the Position, Diameter, and Presence or Absence of Intraluminal Gas 소아에서정상충수의 Multi-Detector CT 소견 : 위치, 직경, 내강가스유무의평가 Woon-Ju Park, MD, Jongchul Kim, MD Department of Radiology, College of Medicine, Chungnam National University, Daejeon, Korea Purpose: To assess the usefulness of multi-detector CT (MDCT) with multiplanar reformations (MPR) for the evaluation of the position, diameter and presence or absence of intraluminal gas in the normal appendix in children. Materials and Methods: From 2007 to 2010, we retrospectively analyzed the MDCT images of normal appendices in 133 children, and evaluated the position, diameter, and presence or absence of intraluminal gas in the appendix. Results: Among the 133 appendices, type I (postileal and medial paracecal position) was found in 64 children, type II (subcecal position) in 22, type III (retrocecal and retrocolic/laterocolic position) in 15, type IV (preileal and medial colic position) in 16, and type V (lower pelvic position) in 16 children. The mean diameter was 5.8 mm ± 1.2 (SD) (range; mm). There was a high correlation between the appendiceal diameter and age (p = 0.000).There was no statistically significant difference in the appendiceal diameter between boys and girls (p = 0.470). Intraluminal gas was found in 115 appendices and there was no statistically significant correlation between the appendiceal diameter and intraluminal gas (p = 0.502). Conclusion: The MDCT with MPR was useful for the evaluation of the normal appendices in children. The procedure may be useful for the diagnosis of equivocal or unusual appendicitis in children. Index terms Appendix, CT Children, Gastrointestinal Tract Received April 5, 2011; Accepted June 7, 2011 Corresponding author: Jongchul Kim, MD Department of Diagnostic Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon , Korea. Tel Fax Copyrights 2011 The Korean Society of Radiology 서론 급성충수염은소아에서복부응급수술의가장흔한원인중의하나이며, 진단이지연되면합병증의위험이증가한다 (1, 2). 소아는의사표현을잘하지못할수있고신체검사가때때로비특이적이기때문에 (3, 4), 소아급성충수염의약 30% 에서임상적인진단이불분명할수있다 (5). 이로인해진단이지연될수있으므로, 소아의급성충수염의진단과배제는빠르고정확하게이루어져야한다. 소아의급성충수염이의심될때현재첫영상진단으로초음파가이용되고있지만이미북미의많은병원에서는첫영상진단법으로 CT를이용하고있다 (6). CT는초음파보다검사자 의존도가낮고천공성충수돌기염에서질환의파급정도를더잘보여주며, 비만한환자에서도검사가용이하고맹장후방에위치하는충수돌기염을진단하는데유용하다 (6). 또한급성충수염을배제할수있는정상충수가 CT에서더잘보이기때문이다 (7-9). 충수의길이와위치는다양한데, 충수의위치가비전형적일경우에는 CT에서충수의확인과해석이어려울수있다 (10). 그리고충수내강의가스존재는정상충수 CT 소견에중요한기준이되지만, 급성충수염에서도내강의가스를보일수있어 (10, 11) 진단에어려움이있을수있다. 최근의 multi-detector CT (MDCT) 및재구성소프트웨어의발달과함께다면적재구성 (multiplanar reformations; 이하 submit.radiology.or.kr 대한영상의학회지 2011;65(2):

2 소아에서정상충수의 Multi-Detector CT 소견 MPR) 기법을사용하여축면 (axial plane) 의공간해상력만큼빠르고높은해상력으로전체복부와골반의이미지를얻을수있게되었다 (12). 이를토대로성인의정상충수에관한연구보고는여러번있었으나 (13, 14) 지금까지저자들이아는한, 소아정상충수에관한보고는드물다. 소아와성인은생활습관이다르고급성충수염의양상도조금다르다. 따라서저자들은 MDCT 소견에서정상충수를보인소아를대상으로 MPR 영상을이용하여, 정상충수의다양한위치, 직경, 내강의가스유무에대해평가하고자하였다. 대상과방법 환자군 2007 년 2월부터 2010 년 5월까지복부질환이의심되어복부 MDCT 를시행한소아중에서정상충수소견을보인 133 명의소아를대상으로 MDCT 소견을후향적으로분석하였다. 남아는 78명, 여아는 55명이었다. 평균연령은 10.9 세였고, 연령분포는 1~15 세 ( 평균 10.9 세 ) 였다. 소아의임상기록을검토하여충수제거술을실시하였거나임상적으로충수염이의심되는경우와염증성장질환이있는경우, 그리고 MDCT 에서충수가보이지않는경우는연구대상에서제외하였다. CT 스캔 CT 검사는 114 명에서 64-slice MDCT (Somatom Sensation, Siemens Medical System, Forchheim, Germany) 를, 그 리고나머지 19 명에서 16-slice MDCT scanner (Somatom Sensation 16; Siemens Medical System, Forchheim, Germany) 를사용하여스캔하였다. 경구조영제와직장조영제는사 용하지않았다. 정맥조영제는비이온성조영제 (Ultravist 370, Schering, Berlin, Germany) 를사용하여주입시작후 70 초 뒤에문맥기영상을얻었다. 환자는앙와위에서 CT 를촬영하 였고, CT 스캔범위는횡경막원개로부터치골결합부위까지 포함하였다. 0.6 mm 두께로스캔한것을 3 mm 두께의축 면, 관상면, 시상면의 MPR 실시간영상으로얻었다 (Wizard, Siemens Medical Solutions VB30). 영상분석 충수는우하복부에있는맹장의후내방벽에서시작되는한 쪽끝이막힌관상구조로 CT 에서연속적으로관찰된다. 고전 적으로장골혈관 (iliac vessels) 의앞쪽, 방광의근처, 또는맹장 의후방에위치한다 (15-17). 영상저장및전송체계 (picture archiving and communication systems; 이하 PACS) 모니터 에서정상충수의 MDCT 영상을분석하였다. 한명의소아영 상전문의와한명의영상의학과전공의가영상분석에참여 하였는데, 이견이있을경우에는상호합의하에결론을도출 하였다. 정상충수의위치, 직경, 내강의가스유무, 충수결석의유 무등으로 CT 소견을분석하였다. 이중에서충수의위치는 5 개의범주로나누었다. I 형은말단회장의후방및맹장의내측, II 형은맹장의하방, III 형은맹장및상행결장의후방혹은외 측, IV 형은말단회장의전방및상행결장의내측, V 형은하부 골반강에충수가있는것으로분류하였다 (Fig. 1). 충수직경 은 CT image 에서가장큰외강의직경을 PACS 모니터를사용 하여측정하였다. Fig.1. Schematic drawing of normal appendiceal position. Type I: postileal and medial paracecal area, Type II: subcecal area, Type III: retrocecal and retrocolic or laterocolic area, Type IV: preileal and medial colic area, Type V: lower pelvic cavity. Courtesy of Oh et al. (10) Note.-pm = psoas muscle, pb = pelvic bone 통계분석통계분석에는 SPSS for Windows 13.0 (SPSS Inc., Chicago, IL, USA) 이사용되었다. 연령과충수직경크기의상관관계는단순회귀분석 (simple regression) 을이용하여분석하였고, 남아와여아의충수직경차이, 충수내강의가스유무에따른직경과및충수결석유무에따른직경의차이는 independent samples t-test 를이용하여분석하였다. 모든통계는 p < 0.05 일때통계적으로유의한차이가있는것으로평가하였다. 192 대한영상의학회지 2011;65(2): submit.radiology.or.kr

3 박운주외 A B C D E Fig. 2. CT images show five types of normal appendiceal position on contrast-enhanced multi-detector CT scans. A. Coronal reformation image shows an appendix (arrow) with intraluminal gas in the medial aspect of the cecum, located between the terminal ileum and the psoas muscle (type I). B. Coronal reformation image shows an appendix (arrow) with no intraluminal gas in the subcecal area (type II). C. Axial image shows an appendix (arrow) with intraluminal gas in the retrocecal area (type III). D. Coronal reformation image shows an appendix (arrow) with no intraluminal gas in the medial aspect of the ascending colon (type IV). E. Coronal reformation image shows an appendix (arrow) with intraluminal gas extending to deep pelvis (type V). 결과 정상충수의위치분포는다음과같았다. I 형 ( 말단회장의후 방및맹장의내측 ) 이 64 예 (48.1%) 로가장많았고 (Fig. 2A), II 형 ( 맹장의하방 ) 이 22 예 (16.6%)(Fig. 2B), III 형 ( 맹장및상 행결장의후방혹은외측 ) 이 15 예 (11.3%)(Fig. 2C), IV 형 ( 말 단회장의전방및상행결장의내측 ) 이 16 예 (12%)(Fig. 2D), V 형 ( 하부골반강 ) 이 16 예 (12%)(Fig. 2E) 였다 (Table 1). 총 133 예중 2 예에서첨단부가비전형적으로위치하는경우가존재하였는데, III 형의 1 예는첨단부가우측간하공간 (subhepatic area) 에위치하였고 (Fig. 3C) V 형의 1 예는첨단부가 5 번요추체의앞쪽중앙에위치하였다 (Fig. 3A, B). 총 133 명의소아에서충수의평균직경은 5.8 ± 1.2 mm Table 1. Types of Appendiceal Position in Children Position No. (%) Type I (postileal and medial paracecal) 64 (48.1) Type II (subcecal) 22 (16.6) Type III (retrocecal and retrocolic / laterocolic) 15 (11.3) Type IV (preileal and medial colic) 16 (12.0) Type V (lower pelvic) 16 (12.0) (SD)(3.2~8.7 mm) 였다. 나이에따른충수의직경은상관결정계수 (R-square) 가 로서충수직경이변하는이유중 50.2% 를나이가설명 한다는것을나타내었고, 통계적으로유의하였다 (r = 0.709, p = 0.000). 그래프상에서대개나이가많을수록충수직경이 더크게나타났다 (Fig. 4). submit.radiology.or.kr 대한영상의학회지 2011;65(2):

4 소아에서정상충수의 Multi-Detector CT 소견 A B C Fig. 3. CT images show unusual locations of appendiceal tip on contrast-enhanced multi-detector CT scans. A, B. Axial image (A) and sagittal reformation images (B) show an appendiceal tip in anterior portion of mid vertrebral body at the L5 level. C. Coronal reformation image shows an appendiceal tip (with intraluminal gas) of retrocolic appendix (arrows) extending to the subhepatic area Diameter (mm) Age (year) Fig. 4. The correlation between appendiceal diameter and age 남아의평균직경은 5.7 ± 1.2 mm였고, 여아의평균직경은 5.8 ± 1.1 mm로, 여아의평균직경이남아보다좀더컸으나통계학적유의성은없었다 (p = 0.470). 충수내강의가스는 115(86.5%) 에서관찰되었고, 18(13.5%) 명에서는충수내강의가스가보이지않았다. 가스가있는경우의평균충수의직경은 5.8 ± 1.2 mm였고, 가스가없는경우는 5.5 ± 1.1 mm로, 가스가있는경우가없는경우보다더컸으나통계학적유의성은없었다 (p = 0.502). 충수결석은 9예 (6.8%) 에서관찰되었다. 그러나이소아들에서는충수내강의가스가존재하였고, 충수가정상직경이었으며, 급성충수염의임상적인소견이없었다. 충수결석이있는경우의평균충수의직경은 6.0 ± 1.3 mm였고, 충수결석이없는경우는 5.7 ± 1.2 mm로, 충수가있는경우가없는경우 보다더컸으나통계학적유의성은없었다 (p = 0.548). 9명중 5명은복부 X-선촬영에서충수결석을관찰할수없었고, 나머지 4명은복부 X-선촬영을실시하지않았다. 고찰 소아에서급성충수염은수술을요하는급성복증의가장흔한원인이다. 그러나소아환자는증상을표현할수없거나임상증상들이장간막림프절염, 소장폐쇄, 게실염, 급성신우신염등의질환과유사할수있다. 따라서임상진단이어려운경우가많다. 12세미만의소아환자에서임상진단만으로급성충수염을오진할확률은 28~58% 에이르고, 특히 2세미만의영아에서는임상진단만으로급성충수염을진단하는것 194 대한영상의학회지 2011;65(2): submit.radiology.or.kr

5 박운주외 이매우어렵다 (6). 그러므로소아의급성충수염의진단과배제에있어서영상진단의역할이상당히중요하다. 영상진단에있어서초음파검사는방사능의노출이없어서유익하나충수내에대변이나가스가차있는경우에는충수를보기가어렵고 (16), 맹장후방에위치한충수와비만환자에서는진단율이떨어진다 (18, 19). 또한시간이많이걸리고검사자에따라진단율이달라지는 (20) 단점이있다. 초음파검사에비해 CT는정상충수가잘보이기때문에 (7-9), 초음파검사보다급성충수염에있어서높은음성예측률을나타낸다 (14). 최근많이시행되고있는 MDCT 를이용한 MPR 은축면영상에의한진단에비해충수돌기위치의확인과충수염진단에더많은도움을줄수있다. 또외과의사에게친숙한해부학적상관관계를보여줄수있을뿐아니라 (6), 정상충수의발견을더용이하게하는것으로보고되었다 (10, 21). 따라서성인이아닌소아에서도정상충수의발견에 MDCT 가도움이될것으로저자들은생각하였다. 관상면의 MPR 은맹장과회맹판의위치를쉽게볼수있게하여충수의시작부위를찾는데도움을주고, 시상면의 MPR 은맹장및상행결장의후방에위치한충수를보는데유용한것으로알려져있다 (10). 저자들의연구에서도축면영상에관상및시상면의영상을추가하여소아의정상충수의전체와부분들을잘볼수있었고, 충수와회맹부사이의해부학적위치관계를파악하는데에도유용하였다. 충수는맹장의후내측에서나와복강내말단회장의후방과요근사이, 또는우상골반부에위치하는경우가가장많다. 맹장및상행결장의하방, 후방, 혹은외측에있기도하고, 맹장및상행결장의내측이나골반강등에다양하게위치할수있다 (10, 22, 23). 맹장이상행결장이후복막강에고정되어있지않을경우에위치가바뀔수있고장의발생과정에서회전이상이있는경우에도충수는정상보다높은위치인간우엽의직하부와같은비전형적인위치에있게된다 (24). 이러한다양한충수의위치에따라소아에서충수염이다른양상을보일수있기때문에, 정상충수의다양한위치에대한정보는소아에서급성충수염의진단이나배제에큰도움을주게된다. Baldisserotto 와 Marchiori(23) 는초음파검사를이용한소아의충수위치에관한연구에서우상골반부 (40%) 에서가장많은충수발견빈도를보였고, 이어서맹장의후방 (27%), 상행결장의내측및장간막 (21%), 골반강 (13%) 순으로충수가위치한다고보고하였다. 저자들의소아정상충수 CT에서는 Baldisserotto 와 Marchiori(23) 의보고와같이우상골반부 (48.1%) 에서가장많은빈도를보였지만, 다른위치의분포에서는맹장의하방 (16.6%), 하부골반강 (12%), 맹장및상행 결장의후방 (12%), 상행결장의내측 (11.3%) 의빈도순으로위치하여골반강의빈도가맹장의하방이나상행결장의내측보다더높은것으로나타났다. 이러한차이는 Baldisserotto 와 Marchiori(23) 의연구대상은급성충수염을가진소아였고저자들의경우는정상충수소견을보인소아를대상으로한것이요인이되지않을까생각되었다. 또한 Oh 등 (10) 이보고한성인의정상충수의 MPR MDCT 에관한보고에서도우상골반부 (44%) 가가장많은빈도를보였다. 하지만그다음으로맹장의후방 (22%), 맹장의하방 (18%), 상행결장의내측및장간막 (9%), 하부골반강 (7%) 의순서로분포하여저자들의소아정상충수의위치와비교할때에성인에서는맹장의후방에위치하는경우가상대적으로소아보다빈도가많은것으로나타났다. 이는정상적인발달과정에서태아및소아때에는충수가맹장의전방에있다가성인이되면서맹장의내측및후방에있게되는것 (24) 에서비롯된것으로생각된다. 저자들의경우, 2예에서첨단부가비전형적으로위치하는경우가존재하였는데, 한예는충수의끝이간우엽의직하부, 다른한예는제5번요추의척추체앞쪽경계의중간에위치하였다. 이러한소견은, 빈도는낮긴하지만, 충수의첨단부가비전형적인위치에있을수있다는개연성을보여준다. 이런사실을주지하는것이소아의급성충수염환자에서충수를발견하기어려운경우에도움이될것으로생각된다. 성인에서와마찬가지로소아의급성충수염을진단하는데있어중요한직접적인소견은 7 mm 이상의가로직경, 내강이보이지않는충수, 그리고강하게조영증강되는충수의벽이다 (6). 또한 CT에서충수결석의존재는, 반드시급성충수염이라고는할수없지만, 급성충수염과많은관련이있는것으로알려져있다 (6). 조영증강 MDCT 를이용한저자들의연구에서정상충수의벽과충수내강의가스를관찰함으로써정상충수의발견이용이하였다. 저자들의경우에서정상충수의평균직경은 5.8 mm (3.2~8.7 mm) 로, 비조영증강 MDCT 로소아의직경을측정한 Ozturkmen 등 (18) 의 5.0 mm (2.8~10 mm) 보다조금컸다. 저자들의연구에서나이에따른충수의직경은상관결정계수 (R-square) 가 로서충수직경이변하는이유중 50.2% 를나이가설명한다는것을나타내었고대개나이가많을수록충수직경이더크게나타났다. 따라서이러한양자의차이는저자들의연구대상의평균연령이 10.9세이고 Ozturkmen 등 (18) 의연구대상의평균연령이 7.3세인것에따른연령분포차이가한가지요인이되지않을까생각된다. 정상충수의내강은다양한정도의가스를가지게된다. 급성충수염에의해충수의기저부에서내강이막히면내강의가 submit.radiology.or.kr 대한영상의학회지 2011;65(2):

6 소아에서정상충수의 Multi-Detector CT 소견 스는흡수되어소실되고, 맹장에서가스역류가차단되어충수내강에서가스를볼수없게된다 (11). Rettenbacher 등 (11) 은우하복통을호소하는환자에서충수내강에가스가보이지않으면충수염의가능성에대한양성예측도가 57%, 가스가보이면음성예측도가 94% 라고보고하였고, 충수내강의가스의존재는급성충수염을배제하는데도움이된다고하였다. 그러나빈도가매우낮긴하지만급성충수염의약 3% 에서도충수내강에서가스가관찰되기때문에, 충수내강에가스가관찰되는소견만으로충수염을배제할수는없다고하였다 (10). 초음파검사를이용한연구에서는정상충수내강의가스가 86% 의높은빈도로관찰된다고하였고 (11), MDCT를이용한저자들의소아정상충수에서도 86.5% 의높은빈도로다양한정도의가스가관찰되었다. 따라서 MPR 을이용한소아 MDCT 에서급성충수염이의심되는환자가충수염의진단기준에합당한소견을보이면충수내강의가스유무와관계없이급성충수염을진단할수있을것이다. 그러나진단기준을적용하기에불충분하거나애매한충수염으로진단이어려운경우에도충수내강에가스가관찰될수있기때문에 (10, 11), 충수내강가스의존재는급성충수염여부를결정하는데유용할것으로생각된다. 소아의 CT에서충수결석의존재는급성충수염과많은관련이있지만, 그것이보인다고반드시급성충수염이라고단언할수는없다 (6). 충수결석이있음에도충수가막히지않으면충수염을일으키지않으므로, 충수염없이도충수결석을보이는경우가 2% 로보고되고있다 (10). 저자들은임상소견이나 CT 소견으로충수염을동반하지않은충수결석을 9예 (6.8%) 에서관찰하였다. 따라서직경의증가가없고주위의염증소견이없는충수에서충수결석이보이는경우에는급성충수염을배제할수있을것으로생각한다. 저자들의연구는다음과같은제한점이있다. 첫째, 정상충수의 MDCT 에관한연구인데도불구하고비교할만한다른문헌이부족하고, 정상충수에관한병리적확진이불가능하며, 후향적연구라는점이다. 둘째, 정상지원자를대상으로한연구가아니라는점이다. 비록 MDCT 에서정상충수의소견을보일지라도, 대상자선정에있어각종암환자나복부질환의진단을위해복부 CT를시행하였던환자들을포함할수밖에없었다. 셋째, 정상충수의직경측정에서부위별로외경의차이를보일수있으므로측정에서의오차가있을수있다는점이다. 소아급성충수염의약 30% 에서임상적인진단이불분명하고 (5), 불행하게도필요없는충수제거술이 20% 이상에서이루어지고있다 (25). 이는앞서언급한다른질환으로부터급성충수염을감별하지못하거나경계에걸쳐있는충수염을진단 하는것이어려움을의미한다. 결론적으로저자들은 MPR 을이용한 MDCT 가소아에서정상충수의위치, 직경, 내강의가스유무를평가하여충수의발견을높일수있음을발견하였다. 이러한소견은진단이어려운경계형의충수염이나비전형적위치에있는충수염의진단에도움을줄수있을것이다. 또한외과적결정의향상과불필요한충수제거술의비율을낮추어줄것으로생각한다. 참고문헌 1. Karakas SP, Guelfguat M, Leonidas JC, Springer S, Singh SP. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol 2000;30: Mullins ME, Kircher MF, Ryan DP, Doody D, Mullins TC, Rhea JT, et al. Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material. AJR Am J Roentgenol 2001;176: Brender JD, Marcuse EK, Koepsell TD, Hatch EI. Childhood appendicitis: factors associated with perforation. Pediatrics 1985;76: Savrin RA, Clatworthy HW Jr. Appendiceal rupture: a continuing diagnostic problem. Pediatrics 1979;63: Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg 1975;110: Lee HS, Kim YT, Kim HC, Bae WK, Kim IY. CT Findings of Acute Appendicitis in Children. Journal of the Korean Radiological Society 2005;52: Rao PM, Rhea JT, Novelline RA, McCabe CJ, Lawrason JN, Berger DL, et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 1997;202: Rao PM, Rhea JT, Novelline RA, Mostafavi AA, Lawrason JN, McCabe CJ. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol 1997;169: Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N. [Ultrasonography of the normal vermiform appendix]. Ultraschall Med 1997;18: Oh KJ, Cho JS, Shin KS, Kim HY, Lim SK, Ohm JY, et al. 196 대한영상의학회지 2011;65(2): submit.radiology.or.kr

7 박운주외 Normal Appendix in Adults: MDCT Findings about the Location, Thickness and the Presence or Absence of Intraluminal Gas. Journal of the Korean Radiological Society 2006;55: Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Frass R, Schneider B, et al. Presence or absence of gas in the appendix: additional criteria to rule out or confirm acute appendicitis--evaluation with US. Radiology 2000; 214: Neville AM, Paulson EK. MDCT of acute appendicitis: value of coronal reformations. Abdom Imaging 2009;34: Keyzer C, Pargov S, Tack D, Créteur V, Bohy P, De Maertelaer V, et al. Normal appendix in adults: reproducibility of detection with unenhanced and contrast-enhanced MDCT. AJR Am J Roentgenol 2008;191: Benjaminov O, Atri M, Hamilton P, Rappaport D. Frequency of visualization and thickness of normal appendix at nonenhanced helical CT. Radiology 2002;225: Ghiatas AA, Chopra S, Chintapalli KN, Esola CC, Daskalogiannaki M, Dodd GD 3rd, et al. Computed tomography of the normal appendix and acute appendicitis. Eur Radiol 1997;7: Wiersma F, Srámek A, Holscher HC. US features of the normal appendix and surrounding area in children. Radiology 2005;235: Applegate KE, Sivit CJ, Myers MT, Pschesang B. Using helical CT to diagnosis acute appendicitis in children: spectrum of findings. AJR Am J Roentgenol 2001;176: Ozturkmen Akay H, Akpinar E, Akgul Ozmen C, Ergun O, Haliloglu M. Visualization of the normal appendix in children by non-contrast MDCT. Acta Chir Belg 2007;107: Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986;158: Garcia K, Hernanz-Schulman M, Bennett DL, Morrow SE, Yu C, Kan JH. Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix. Radiology 2009;250: Jan YT, Yang FS, Huang JK. Visualization rate and pattern of normal appendix on multidetector computed tomography by using multiplanar reformation display. J Comput Assist Tomogr 2005;29: Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215: Baldisserotto M, Marchiori E. Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol 2000;175: Schumpelick V, Dreuw B, Ophoff K, Prescher A. Appendix and cecum. Embryology, anatomy, and surgical applications. Surg Clin North Am 2000;80: Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 1999;229: submit.radiology.or.kr 대한영상의학회지 2011;65(2):

8 소아에서정상충수의 Multi-Detector CT 소견 소아에서정상충수의 Multi-Detector CT 소견 : 위치, 직경, 내강가스유무의평가 박운주 김종철 목적 : 소아에서정상충수의위치, 직경및내강의가스를평가하는데있어서다면적재구성 (multiplanar reformations; 이하 MPR) 을이용한다검출식 CT (multi-detector computed tomography; 이하 MDCT) 의유용성에대하여알아보고자한다. 대상과방법 : 2007 년부터 2010 년까지정상충수를보인 133 명의소아복부 MDCT 에서, 충수의위치, 직경, 내강의가스유무를후향적으로분석하였다. 결과 : 충수의위치는 133 예중에서 I형 ( 말단회장후방및맹장의내측 ) 64예, II형 ( 맹장의하방 ) 22예, III 형 ( 맹장및상행결장의후방혹은외측 ) 15예, IV형 ( 말단회장전방및상행결장의내측 ) 16예, V형 ( 하부골반강 ) 16예였다. 소아의정상충수직경의평균은 5.8 ± 1.2 mm(sd) (range: 3.2~8.7 mm) 였다. 나이와충수직경은통계학적으로높은상관관계가있었다 (p = 0.000). 충수직경과성별사이에통계학적유의성은없었다 (p = 0.470). 내강가스는 115 예에서보였고내강의가스나사이에는상관관계가없었다 (p = 0.502). 결론 : MPR 을이용한 MDCT 는소아의정상충수를평가하는데유용하였다. 또한진단하기애매모호한충수염이나비전형적위치의충수염을진단하는데도움이될것으로생각된다. 충남대학교의과대학영상의학과학교실 198 대한영상의학회지 2011;65(2): submit.radiology.or.kr

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