대한영상의학회지 2010;63: 연부조직석회화병변의특징적영상소견 : 임상화보 1 이연수 연부조직의석회화는비특이적인국소반응에의해보일수있으나근본적인질환의원인을나타낼수있다. 이러한석회화를이루는병변의특성에따라환자의진단및치료의방향이달라진다. 그생성기전에따라연부조직의

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1 연부조직석회화병변의특징적영상소견 : 임상화보 1 이연수 연부조직의석회화는비특이적인국소반응에의해보일수있으나근본적인질환의원인을나타낼수있다. 이러한석회화를이루는병변의특성에따라환자의진단및치료의방향이달라진다. 그생성기전에따라연부조직의석회화는전이석회화, 석회증, 이영양성석회화로분류된다. 그러나방사선학적영상에서는이들의형성부위및모양에의한분류가더진단에도움을줄수있다. 이임상화보에서는연부조직에석회화를보일경우, 그발생부위를중심으로혈관, 관절주위, 관절피막, 힘줄, 점액낭, 연골, 인대, 종양내의석회화로나누어, 그원인과특징적인방사선학적소견을서술하고자한다. 연부조직의석회화 (calcification) 는방사선영상소견에서진단에중요한역할을한다. 연부조직내에석회염 (calcium salts) 의침착을무기질침착 (mineralization) 또는석회화라 에저자는연부조직에석회화를보이는경우, 진단에도움이되는특징적인방사선학적소견을발생부위를중심으로서술하고자한다. 하며, 만일뼈잔기둥 (bony trabecula) 이무기질침착내에보 이면이를골화 (ossification) 라한다 (1). 뼈의석회화 (osseous calcification) 는대개주변부에고음영을보이며미성숙된무기질침착이피질을형성한다. 연골의석회화 (chondroid calcification) 는뼈잔기둥이나피질의구조가없고, 불규칙한반점, 원, 선형또는고리와호모양을보인다. 이러한석회화를이루는병변에대한정확한인지는환자의진단및치료에정확한정보를제공할수있다. 연부조직에서석회화를보일경우생성기전에따라칼슘과인의대사장애가 혈관석회화동맥석회화중혈관내막동맥경화증 (intimal arteriosclerosis) 은동맥의내막에죽상판 (atheromatous plaques) 을형성하며, 석회화되었을때다양한크기의불규칙한판으로보인다. 동맥중간막경화증 (medial arteriosclerosis) 의석회화는밀집된연결링의형태로나타난다. 발의소동맥의석회화는당뇨병의특징이며 (Fig. 1), 손과발의소동맥석회화는 있는 환자에서 생기는 전이 석회화 (metastatic 만성신부전증에서 나타난다. 정맥 석회화는 정맥돌 calcification), 칼슘대사가정상이며칼슘이피부와피하조직에있는석회증 (calcinosis), 감염, 종양등에서조직괴사에의한변성으로생기며대사장애는없는이영양성석회화 (dystrophic calcification) 로나눌수있다. 그외에혈청내증가한인수치와정상칼슘수치를갖는드문가족성질환으로관절주위, 피하의칼슘침착으로나타나는종양석회화 (tumoral calcification) 와정상대사를가진사람들에서생긴 (phlebolith) 과정맥정체내의석회화 (calcification with venous stasis) 로나눌수있는데정맥돌은정맥내의석회화된혈전이며, 하지의정맥류 (varicose vein) 나해면상혈관종 (cavernous hemangioma) 에서보이고, 고리같은모양을보이기도한다 (Fig. 2). 정맥정체내석회화는오랜기간의정맥정체에의해정맥류종창과혈전증에이차적으로나타나며, 피하조직에얇은줄무늬모양의석회화로보인다 (Fig. 3). 특발성석회화 (idiopathic calcification), 만성신부전증과칼 슘및인의대사장애를갖는환자에서주로생기는석회화인칼시필락시스 (calciphylaxis) 등으로생성기전에따른분류가세분되었으나 (2-4), 방사선학적영상에서는이들의형성부위및모양에의한분류가진단에더도움을줄수있다. 이 관절주위의석회화 (Periarticular Calcification) 부갑상샘항진증, 신장성골형성장애 (renal osteodystrophy), 비타민디과다증 (hypervitaminosis D), 우유알칼리증후군 (milk-alkali syndrome), 교원혈관병 (collagen vascular 1 가톨릭대학교의과대학대전성모병원영상의학과 이논문은 2010년 5월 14일접수하여 2010년 6월 28일에채택되었음. disease), 특발종양석회증 (idiopathic tumoral calcinosis), 275

이연수 : 연부조직석회화병변의특징적영상소견 Fig. 1. DM foot in a 63-year-old man with skin necrosis.

Calcifications with venous stasis in a 46-year-old man.

Cavernous hemangioma in a 20-year-old man.

(arrow), suggesting thromboliths. Fig. 4. Renal osteodystrophy in a 48-year-old woman.

2 이연수 : 연부조직석회화병변의특징적영상소견 Fig. 1. DM foot in a 63-year-old man with skin necrosis. nteroposterior (P) plain radiograph of foot shows tubular, elongated arterial calcifications (arrow). Fig. 3. Calcifications with venous stasis in a 46-year-old man. P plain radiograph of tibia reveals stripe like shadows of calcifications (arrow). Fig. 2. Cavernous hemangioma in a 20-year-old man. Lateral plain radiograph of forearm shows several round, ring like calcifications including central lucencies (arrow), suggesting thromboliths. Fig. 4. Renal osteodystrophy in a 48-year-old woman. Posteroanterior (P) plain radiograph of hand shows several nodular calcifications along the periarticular, periosteal spaces and subperiosteal resorptions in the phalangeal bones. Globular calcifications are also seen in the ulnocarpal periarticular area (arrow) and soft tissue (arrowhead) of the distal radial level. 276

부갑상선기능저하증, 칼슘피로인산염침착병 (calcium pyrophosphate deposition disease, 이하 CPPD), 통풍, 칼슘수산화인회석침착병 (hydroxyapatite deposition disease, 이하 HDD), 사르코이드증 (sarcoidosis) 등에서볼수있다.

석회화는혈청내칼슘과인의수치가증가하면서칼슘수산화인회석 (calcium hydroxyapatite) 과무정형의 (amorphous) 칼슘인의전이침착 (metastatic deposition) 이증가하여생기는것으로알려져있고, 관절주위의석회화는큰관절과손, 발의관절등을포함한다. 이중일부는크기가커지면서종양처럼보이며잘분리되고분엽된종괴로나타난다.

Pseudohypoparathyroidism in an 11-year-old female with delayed development, mental retardation and short stature.

3 부갑상선기능저하증, 칼슘피로인산염침착병 (calcium pyrophosphate deposition disease, 이하 CPPD), 통풍, 칼슘수산화인회석침착병 (hydroxyapatite deposition disease, 이하 HDD), 사르코이드증 (sarcoidosis) 등에서볼수있다. 부갑상샘항진증부갑상선호르몬의과다분비에의해파골세포 (osteoclast) 의증가로뼈의흡수를일으킨다. 일차는부갑상선의이상으로, 이차는만성신부전증등의저칼슘상태에의해이차적부갑상선비대가일어나는경우를말한다. 갈색종양 (brown tumor) 과연골석회화증 (chondrocalcinosis) 은일차에, 연부조직석회화와혈관석회화, 골경화증은속발성에잘생긴다. 석회화는혈청내칼슘과인의수치가증가하면서칼슘수산화인회석 (calcium hydroxyapatite) 과무정형의 (amorphous) 칼슘인의전이침착 (metastatic deposition) 이증가하여생기는것으로알려져있고, 관절주위의석회화는큰관절과손, 발의관절등을포함한다. 이중일부는크기가커지면서종양처럼보이며잘분리되고분엽된종괴로나타난다. 특히, 만성신부전증환자에서골연화증을가져오거나속발성부갑상선기능항진에의한방사선소견을볼수있는데이를신성골이영양증이라하며 (Fig. 4), 골연화증, 구루병, 특발성부갑상선기능항진, 골다공증, 연부조직석회화, 골경화증, 럭비운동복모양척추 (rugger-jersey s spine) 등을보인다 (5). Fig. 5. Pseudohypoparathyroidism in an 11-year-old female with delayed development, mental retardation and short stature. Plain radiograph of hand shows a periarticular calcification adjacent to fourth metacarpophalangeal joint (arrow). Positive metacarpal sign is also seen (line). 가부갑상선기능저하증 (Pseudohypoparathyroidism) 특발성부갑상선기능저하증의많은특징, 즉, 저칼슘혈증, 고인산혈증, 대뇌기저핵과연부조직의석회화를보이는유전성질환으로짧은중수골, 중족골, 손발가락뼈들을특징으로한다. 양성중수골징후 (positive metacarpal sign) 를보인다 (Fig. 5). 관절피막, 건, 점액낭에생긴석회화칼슘피로인산염침착질환, 칼슘수산화인회석침착질환등에서볼수있다. Fig. 6. Calcific tendinitis in a 53-yearold man in the shoulder.. P plain radiograph of right shoulder shows a globular calcified density (arrow) adjacent to the greater tuberosity of humerus.. Coronal fat suppressed T1-weighted MR arthrography reveals a dark signal intensity lesion (arrow) in the distal supraspinatus tendon, suggesting calcific tendinitis. 277

이연수 : 연부조직석회화병변의특징적영상소견 Fig. 7. Calcific tendinitis of the flexor carpi ulnaris tendon in a 36-year-old man.

. Coronal T2-weighted MR image of wrist shows high signal intensity including dark signal (arrow) at the pisiform insertion

Calcific tendinitis of right hip in a 56-year-old woman.

, C. Coronal () and axial (C) fat suppressed T2-weighted MR images of hip reveal the calcification (arrow) in the femoral

4 이연수 : 연부조직석회화병변의특징적영상소견 Fig. 7. Calcific tendinitis of the flexor carpi ulnaris tendon in a 36-year-old man.. Plain radiograph of wrist show irregular, linear calcified densities (arrow) in the ulnocarpal space.. Coronal T2-weighted MR image of wrist shows high signal intensity including dark signal (arrow) at the pisiform insertion portion of flexor carpi ulnaris tendon, suggesting calcific tendinitis. Fig. 8. Calcific tendinitis of right hip in a 56-year-old woman.. Plain radiograph of right hip shows a globular appearance of calcified density (arrow) adjacent to the greater trochanter., C. Coronal () and axial (C) fat suppressed T2-weighted MR images of hip reveal the calcification (arrow) in the femoral insertion portion of gluteus medius tendon as well as the high signal intensity surrounding dark signal, which is consistent with inflammation. C 칼슘수산화인회석침착질환석회화성건염과석회화성활액낭염을의미하며그발생기원은알수없으나, 건의위험대 (critical zone) 의저산소증이원인으로생각되고있고, 섬유연골화생 (fibrocartilaginous metaplasia) 과석회화를일으킨다. 어깨의원위극상건의위험대가잘발생하는부위이며 (Fig. 6), 그외손목 (Fig. 7), 고관절 (Fig. 8) 에도잘생긴다. MRI상모든펄스연쇄 (pulse sequence) 에저신호강도를보이며, 염증때문에 T2 강조영상에서고신호강도를보인다. 건과관절주변의석회화에대한기 (phase) 로첫번째기는칼슘이건내에있고, 두번째기는칼슘의크기가증가하여견봉하점액낭 (subacromial bursa) 의바닥을거상시키며, 세번째기는접착성의관절주위염증 278

(adhesive periarthritis) 이생기고, 네번째기는칼슘의골내소방형성 (intraosseous loculation), 다섯번째기는아령형소방형성 (dumbbell loculation) 을의미한다 (6).

칼슘피로인산염침착질환, 부갑상선항진증, 혈색소증 (hemochromatosis), 윌슨병 (Wilson s disease), 통풍, 퇴행성관절염등에서볼수있다. 특히, 결정유발관절병 (Crystal Induced rthropathy) 으로칼슘피로인산염침착질환, 칼슘수산화인회석침착질환, 통풍이이에속한다.

칼슘피로인산염결 칼슘피로인산염침착질환칼슘피로인산염결정들 (Calcium pyrophosphate dehydrate crystals) 이연골, 관절및관절주위조직에침착하여생기며, 유전성, 산발성 (sporadic), 특발성, 또는다른질환과동반된형으로분류한다.

5 (adhesive periarthritis) 이생기고, 네번째기는칼슘의골내소방형성 (intraosseous loculation), 다섯번째기는아령형소방형성 (dumbbell loculation) 을의미한다 (6). 연골에생긴석회화연골석회화증은유리연골 (hyaline cartilage) 혹은섬유연골 (fibrocartilage) 내칼슘염이있을때쓰는기술용어이다. 섬유연골은무릎반월판, 손목삼각형섬유연골복합 (triangular fibrocartilage complex, 이하 TFCC), 치골결합등에생기며, 유리연골은관절면을따라선형으로보인다. 칼슘피로인산염침착질환, 부갑상선항진증, 혈색소증 (hemochromatosis), 윌슨병 (Wilson s disease), 통풍, 퇴행성관절염등에서볼수있다. 특히, 결정유발관절병 (Crystal Induced rthropathy) 으로칼슘피로인산염침착질환, 칼슘수산화인회석침착질환, 통풍이이에속한다. (metacarpophalangeal joint), 대능형골주상골관절 (trapezioscaphoid joint), 슬개골대퇴관절, 거종주관절 (talocalaneonavicular joint) 에퇴행성관절염이있을때 CPPD의가능성을생각해보아야한다 (7). 연골하낭종의형성이심해지면골의허탈과골편형성을일으키고, 유리체를형성하며, 여러형태의뼈돌기형성을한다. 칼슘피로인산염결 칼슘피로인산염침착질환칼슘피로인산염결정들 (Calcium pyrophosphate dehydrate crystals) 이연골, 관절및관절주위조직에침착하여생기며, 유전성, 산발성 (sporadic), 특발성, 또는다른질환과동반된형으로분류한다. 연골석회화증, 활액막, 피막석회화, 건, 점액낭, 인대, 연부조직, 혈관석회화의형태로나타날수있고, 피로인산염관절병증 (pyrophosphate arthropathy) 으로나타나기도한다. 방사선소견은드문관절부위의퇴행성변화로특히요골쪽손목, 중수지절관절 Fig. 10. Gouty arthritis in a 42-year-old man. Plain radiograph of foot reveals bony erosion including stippled calcifications (arrow) at the first medial metatarsal head. nother well defined bony erosion with small calcifications (arrowhead) in the second metatarso-cuneiform joint. Fig. 9. CPPD in an 83-year-old woman.. Plain radiograph of hand shows nodular calcifications (arrows) along the MCP joints and triangular calcifications (arrowhead) in the ulnocarpal joint, representing TFCC calcifications.. Lateral radiograph of ankle shows a curvilinear calcification (arrow) along the talonavicular joint. 279

이연수 : 연부조직석회화병변의특징적영상소견 정들이관절연골, 관절주변조직에침착으로생기며, 중수지절관절, 특히두, 세번째의침범이특징이다.

통풍성관절염통풍은퓨린대사의최종산물인요산의축적으로인해고요 산혈증이발생하며요산염이관절의활액막, 연골, 연골하골, 관절주위조직, 피하조직및신장에침착하여재발성관절염을일으키는질환이다.

돌출된변연부 (overhanging edge) 를보이는관절주위골미란이비교적특징적인소견이며관절간격이유지 C Fig. 11. CREST syndrome in a 62-year-old woman.

. Lateral radiograph of knee reveals stippled calcifications (arrow) in the subcutaneous tissue of prepatellar

Sagittal T2-weighted MR image of knee shows several dark signals (arrow) in the prepatellar subcutaneous area.

6 이연수 : 연부조직석회화병변의특징적영상소견 정들이관절연골, 관절주변조직에침착으로생기며, 중수지절관절, 특히두, 세번째의침범이특징이다. 연골석회화증이 TFCC, 무릎반월판, 치골결합, 고관절과완관절에생길수있으며, 활액막, 피막석회화증이손목, 무릎, 중수지절관절에생길수있다 (Fig. 9). 통풍성관절염통풍은퓨린대사의최종산물인요산의축적으로인해고요 산혈증이발생하며요산염이관절의활액막, 연골, 연골하골, 관절주위조직, 피하조직및신장에침착하여재발성관절염을일으키는질환이다. 말초관절을잘침범하고특히발, 손, 손목관절과주관절의방사선학적스크리이닝이필요하다. 단순방사선소견상첫번째중족골지골관절을가장흔히침범하고통풍결절은관절주위연부조직에침착하며내부에석회화를보일수있다. 돌출된변연부 (overhanging edge) 를보이는관절주위골미란이비교적특징적인소견이며관절간격이유지 C Fig. 11. CREST syndrome in a 62-year-old woman.. Lateral radiograph of forearm shows a nodular and lobulated calcification (arrow) in the subcutaneous tissue.. Lateral radiograph of knee reveals stippled calcifications (arrow) in the subcutaneous tissue of prepatellar region. C. Sagittal T2-weighted MR image of knee shows several dark signals (arrow) in the prepatellar subcutaneous area. Fig. 12. Tumoral calcinosis in a 12- year-old man.. P plain radiograph of foot shows multiloculated calcified juxta-articular mass (arrow) adjacent to DIP joint of little toe.. xial T1-weighted MR image of foot shows several calcified nodules with dark signal intensity (arrow) around the DIP joint of little toe. 280

되고관절주위골다공증이없는것이류마티스관절염과의감별점이다 (Fig. 10). 불규칙한또는구름같은방사선고밀도부위 (radiodense area) 로보이며, 그외연골석회화증이 5~32% 에서보인다 (8).

특히 CREST (calcinosis, Raynaud s phenomenon, esophageal hypomobility, sclerodactyly and telangiectasia) 증후군은피부석회증 (calcinosis cutis), 레이노현상,

Pellegrini Stieda disease in a 58-year-old woman.

. Coronal fat suppressed T2-weighted MR image of knee shows a nodular dark signal intensity lesion (arrow) in the thickened medial collateral

Cavernous hemangioma in a 25-year-old woman.

7 되고관절주위골다공증이없는것이류마티스관절염과의감별점이다 (Fig. 10). 불규칙한또는구름같은방사선고밀도부위 (radiodense area) 로보이며, 그외연골석회화증이 5~32% 에서보인다 (8). 간질성석회화 (Interstitial Calcinosis) 범발성석회증 (calcinosis universalis), 국한성석회증 (calcinosis circumscripta), 종양성석회화증 (tumoral calcinosis) 등으로세분한다. 특히 CREST (calcinosis, Raynaud s phenomenon, esophageal hypomobility, sclerodactyly and telangiectasia) 증후군은피부석회증 (calcinosis cutis), 레이노현상, 식도저운동성, 손가락이나발가락의피부경화 (sclerodactyly), 모세혈관확장증이보일때를말한다 (Fig. 11). 종양성석회화증은관절근접연부조직에칼슘의축적이특징인드문질환으로대개고관절, 어깨등 Fig. 13. Pellegrini Stieda disease in a 58-year-old woman.. Plain radiograph of knee reveals an ovoid shaped calcification (arrow) adjacent to medial femoral condyle.. Coronal fat suppressed T2-weighted MR image of knee shows a nodular dark signal intensity lesion (arrow) in the thickened medial collateral ligament (MCL) at the femoral insertion portion, suggesting chronic injury of MCL with calcification. C Fig. 14. Cavernous hemangioma in a 25-year-old woman.. Plain radiograph of forearm shows a soft tissue mass including several phleboliths (arrow) in the volar aspect of forearm.. Coronal T1-weighted MR image of forearm demonstrates a multilobular contour of the soft tissue mass and internal signal voids (arrow) due to phleboriths. C. xial fat suppressed T2-weighted MR image reveals a soft tissue mass of multilobulated, multiseptated high signal intensity, containing several calcifications (arrow). 281

이연수 : 연부조직석회화병변의특징적영상소견 의큰관절부위에생기며, 주관절, 발에생기기도한다 (Fig. 12). 일차성정상인산염혈증종양성석회화증 (normal phosphatemic tumoral calcinosis) 은혈청칼슘과인수치가정상이며, 동반되는신장, 대사성또는교원질질환 (collagen disorder) 등이없는경우이다.

젊은연령 (10대나 20대 ) 에호발하고, 방사선사진상석회화종괴가다소방형성형태로철망 (chicken wire) 또는조약돌모양 (cobblestone appearance) 으로보인다 (9).

종양내의석회화 (Calcification in Tumor) 연부조직종양중에서양성종양중혈관종은정맥돌로, 지방종, 황색종 (xanthoma), 과오종 (hamartoma) 등은명확하게경계지워지는주변부석회화로나타난다.

8 이연수 : 연부조직석회화병변의특징적영상소견 의큰관절부위에생기며, 주관절, 발에생기기도한다 (Fig. 12). 일차성정상인산염혈증종양성석회화증 (normal phosphatemic tumoral calcinosis) 은혈청칼슘과인수치가정상이며, 동반되는신장, 대사성또는교원질질환 (collagen disorder) 등이없는경우이다. 일차성고인산염혈증종양성석회화증 (hyperphosphatemic tumoral calcinosis) 은가족성질환이며혈중증가한인수치와정상칼슘인경우이다. 이차성은대사성석회화에의해일어난다. 젊은연령 (10대나 20대 ) 에호발하고, 방사선사진상석회화종괴가다소방형성형태로철망 (chicken wire) 또는조약돌모양 (cobblestone appearance) 으로보인다 (9). 건과인대의석회화 (Calcification of Tendons and Ligaments) 펠리그리니스티다증후군 (Pellegrini-stieda syndrome) (Fig. 13) 은내측대퇴골과의상연에불규칙한석회화또는골화가보이며내측부인대의이전손상을의미한다. 그외, 아킬레스건, 슬개건에도생길수있다. 종양내의석회화 (Calcification in Tumor) 연부조직종양중에서양성종양중혈관종은정맥돌로, 지방종, 황색종 (xanthoma), 과오종 (hamartoma) 등은명확하게경계지워지는주변부석회화로나타난다. 악성종양중석 회화를나타내는종양으로는지방육종, 섬유육종, 악성섬유조직구종, 활액육종, 횡문근육종등이있으며, 불규칙한, 비정형성의희미한석회화형태로나타난다. 그외연골종양으로연골종, 연골육종등에서도석회화를볼수있다. 혈관종해면상혈관종은 30-50% 에서중앙이방사선투과성인원형석회화로보이는정맥돌을포함하고있다 (10). MRI의 T1 강조영상에서저신호강도와함께지방이나느린혈류에의한고신호강도를보일수있고, T2 강조영상에서혈관에해당하는높은신호강도를보인다. 조영증강이잘되며내부는저신호강도의정맥돌을볼수있다 (Fig. 14), 지방육종단순촬영에서지방음영을볼수있고석회화는 10% 이하에서나타난다. 잘분화된지방육종은지방종과유사한 MRI 소견을보이며, 내부에격막또는결절구조들로되어있고, 다양한조영증강을보인다 (Fig. 15). 점액성과원형세포지방육종은지방성분이적으며, 특히점액지방육종은점액조직이많을수록낭종처럼보이나, 다양한정도의조영증강으로낭종과구분할수있다 (11). 활액육종주로사지에서발생하는간엽성종양 (mesenchymal tumor) 으로이상성 ( 상피성과방추성세포 ) 의조직소견을갖 C Fig. 15. Well differentiated liposarcoma in a 42-year-old man.. Lateral radiograph of femur shows a soft tissue mass of the fatty nature including nonspecific calcifications (arrow) and ossifications in the posterior aspect of distal femur.. Coronal T1-weighted MR image of thigh reveals a mainly high signal intensity mass with irregular septa and dark signals (arrows), suggesting calcifications. C. Coronal fat suppressed T2-weighted MR image shows fat suppression of the adipose tissue and increased signal intensity of no adipose area in the superomedial aspect of mass (arrow). 282

고, 비교적젊은연령 (15세-40세) 에자주생긴다. 생기는위치는건막, 점액낭, 활액막에근접한관절근처이나, 관절외위치가더흔하다. 30% 정도에서석회화를보이는것으로되어있고 10-20% 는주위골을침범한다 (Fig. 16).

(12). 골외연골종 30~40세에잘생기며, 손과발이자주발생하는부위이고, 연부조직고엽을경계짓는원형, 고리모양또는결절모양의석회화가 33~77% 에서보인다 (13). MRI 상 T2 강조영상에서고신호강도, T1 강조영상에서저신호강도를포함한중등도신호강도를보인다 (Fig. 17).

. Sagittal fat suppressed T2-weighted MR image demonstrates well defined, a lobulated mass in the medial midfoot including calcification (arrow).

9 고, 비교적젊은연령 (15세-40세) 에자주생긴다. 생기는위치는건막, 점액낭, 활액막에근접한관절근처이나, 관절외위치가더흔하다. 30% 정도에서석회화를보이는것으로되어있고 10-20% 는주위골을침범한다 (Fig. 16). MRI 상 T2 강조영상에서불균질한신호강도를보이는데, 이는 삼중신호 라하여종괴내부에세포질에의한중간신호강도, 낭성변화나출혈 (40% 정도 ) 에의한고신호강도, 섬유질또는석회화에의한저신호강도의 3 성분이보이는것을말하며, 출혈성분은 fluid-fluid level의형태로나타나기도한다 (12). 골외연골종 30~40세에잘생기며, 손과발이자주발생하는부위이고, 연부조직고엽을경계짓는원형, 고리모양또는결절모양의석회화가 33~77% 에서보인다 (13). MRI 상 T2 강조영상에서고신호강도, T1 강조영상에서저신호강도를포함한중등도신호강도를보인다 (Fig. 17). 활액막골연골종 (Synovial Osteochondromatosis) 특발성형은활액막하결체조직의화생 (metaplasia) 으로인해연골결절들이관절, 건또는점액낭에형성되며이어석회화또는골화로진행되는병변으로원인은아직명확하게알 Fig. 16. Synovial sarcoma in a 40-yearold man.. Plain radiograph of foot shows bony destruction including irregular small calcifications (arrow) in the first metatarsal bone.. Sagittal fat suppressed T2-weighted MR image demonstrates well defined, a lobulated mass in the medial midfoot including calcification (arrow). The signal intensity of mass shows heterogeneous signal intensity. Fig. 17. Synovial chondroma in a 56- year-old woman.. Plain lateral radiograph of knee shows an ovoid shaped calcified nodule (arrow) in the suprapatellar area.. Sagittal T2-weighted MR image reveals an ovoid mass dark signal intensity including central high signal intensity (arrow) in the fluid filled suprapatellar bursa. 283

이연수 : 연부조직석회화병변의특징적영상소견 C Fig. 18. Synovial chondromatosis in a 62-year-old woman.. Plain radiograph shows multiple calcifications of right hip (arrow).

xial enhanced fat suppressed T1-weighted MR image demonstrates many loose bodies (arrows) without contrast enhancement in the enhanced synovial fluid. 려져있지않다 (Fig. 18).

다양한연부조직내의석회화병변의원인및영상학적인특징에대한이해는병변의정확한진단, 추가검사의필요성, 그리고치료방법의결정에중요한역할을할것이다. 론 참고문헌 1. Gartner L, Pearce CJ, Saifuddin. The role of the plain radiograph in the characterisation of soft tissue tumours.

10 이연수 : 연부조직석회화병변의특징적영상소견 C Fig. 18. Synovial chondromatosis in a 62-year-old woman.. Plain radiograph shows multiple calcifications of right hip (arrow).. xial T2-weighted MR image of hip reveals multiple loose bodies (arrows). C. xial enhanced fat suppressed T1-weighted MR image demonstrates many loose bodies (arrows) without contrast enhancement in the enhanced synovial fluid. 려져있지않다 (Fig. 18). 이차성골연골종은외상, 박리성골연골염, 심한퇴행성관절염, CPPD, 신경병증성관절병증등에서볼수있으며, 관절내유리체의숫자가적으며크기가다양하다. 결 단순방사선영상에서연부조직내에석회화가보일때, 질환과는관련이없는우연한소견일수있으나, 석회화를이루는병변을나타낼수도있다. 다양한연부조직내의석회화병변의원인및영상학적인특징에대한이해는병변의정확한진단, 추가검사의필요성, 그리고치료방법의결정에중요한역할을할것이다. 론 참고문헌 1. Gartner L, Pearce CJ, Saifuddin. The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol 2009; 38: Resnick D. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002: Hussmann J, Russell RC, Kucan JO, Khardori R, Steinau HU. Soft tissue calcifications: differential diagnosis and therapeutic approaches. nn Plast Sur 1995;34: oulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic disease. Semin rthritis Rheum 2005;34: Jevtic V. Imaging of renal osteodystrophy. Eur J Radiol 2003:46: Jung C, Gentili, Chew FS. Calcific tendinosis and periarthritis. Classic magnetic resonance imaging appearance and associated findings. J Comput ssit Tomogr 2004;28: Saffar P. Chondrocalcinosis of the wrist. J Hand Surg r 2004;29: Resnick D. Calcium Pyrophosphate Dihydrate Crystal Deposition Disease. In Resnick D. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002: Smack D, Norton S, Fitzpatrick JE. Proposal for a pathogenesisbased classification of tumoral calcinosis. Int J Dermatol 1996;36: Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. Philadelphia: W.. Saunders Co., 1997: Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006: Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol 2009;72: Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006:

11 J Korean Soc Radiol 2010;63: Radiological Features of Soft Tissue Calcification: Pictorial Essay 1 Yeon Soo Lee, M.D. 1 Department of Radiology, Daejeon St. Mary s Hospital, The Catholic University of Korea Calcification of soft tissue may represent a nonspecific local response or be a manifestation of underlying disease. The diagnosis and principle of treatment varies depending on the characteristics of the calcified lesions. Soft tissue calcification is classified by mechanism into 3 types: metastatic calcifications, calcinosis, and dystrophic calcifications. However, classification according to the site and shape of calcification may be more helpful for a clinical diagnosis. The purpose of this pictorial essay is to classify soft tissue calcifications according to their location: vessel, periarticular, joint capsule, tendon, bursa, cartilage, ligament, and in tumors, as well as to document the characteristic radiological findings and causes of calcifications. Index words : Soft Tissue Injuries Calcification, Physiologic Radiography Magnetic Resonance Imaging ddress reprint requests to : Yeon Soo Lee, M.D., Department of Radiology, Daejeon St. Mary s Hospital, The Catholic University of Korea, 520-2, Deaheung-dong, Jung-gu, Daejeon , Korea. Tel Fax yslee1074@catholic.ac.kr 285

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( ) Jkra076.hwp Vol. 11, No. 4, December, 2004 Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic