大韓放射線훌훌學슐誌 Vo l. 때 n, No. 2, 1981 전산화단층촬영을이용한투명중격실강 CCavum septum pellucidum) 의 진단 부산에러놀병원방사선과 배병호 김정화 오기찬 김양숙 박복환 - Abstract- Computed Tomography in the Diagnosis of Cavum Septum PeUucidum B.H. Bae, M.D., J.H. Kim, M.D., K. C. Oh, M. D., Y.S. Kim, M.D. and B.H. Park, M.D. The cavum septum pellucidum is an anatomical variants of the septum pellucidum, and Iying between two lateral ventricles and this is referred to as the fifth ventricle. Occasionally,posterior extension of the cavum septum pellucidum towards the splenium is seen and this is known as the cavum vergae, or sixth ventricle. The septum is double membrane and occasionally a narrow cavity containing CSF is present between these membrane. The roof of the cavum septum pellucidum is formed by the corpus callosum and its floor by the anterior pillars of the fornix. This cavum outlined with air is occasionally seen in the pneumoencephalo. graphy. Brain CT scans of 1000 patients were performed, and the diagnosis could be made on the basis of the characteristic shape, density and location. Other diagnostic procedure are not necessary in these cases. Patients were examined with CT scanner from June. 80 to Dec. 80, at department of radiology, Maryknoll Hospital, and 13 cases were diagnosed. CT findings of the cavum septum pellucidum consists of slit like elongated triangular or wedge shape, isodensity with CSF of the lateral ventricle and location between both lateral ve ntricles. The recognition of the CT patt-.:rn of the cavum septum pellucidum becomes exceedingly important for differenciating between midline cystic lesions, such as neuroepithel ial cysts, colloid cysts, cysts of cavum velum interpositum, paracytic cysts, craniopharyngiomas, the leaves of the septum pellucidum or tumors of the corpus callosum. Before availability of the computed tomography, radiographic examination of the cavum septum pellucidum consisted mainly of pneumoencephalography and ventriculography, however, now CT scan. ning provided the best radiographic means of the demonstrating the cavum septum pellucidum. 1. 서론 히발견되어지는뇌의해부학적二쿠 f조물은아니며 1, 2 3 껴, 4 5κ 6밍 ) 뇌의천산화닥단f 층촬영이시행되기전에는신경방사선과학적으로첨업성진단방법안뇌의공기조영술과뇌 뇌의천산화단층촬영이 입상에이용된이래뇌벙변의 실촬영슐에의해서만진단이 가능하였으나현재는비 진단및정상적안해부학적 구조물의진단에많은도웅 칭입성진단방법안 뇌의 천산화단층촬영을이용함으로 을준것운주지의사실이마. 써쉽게진단할수있게 되었다. 투영중격실강 ( cavum septum p e ll ucidum) 이란흔 저자들윤 1980 년 6 월부터 1980 년 12 월까지뇌의천 - [93-
산화단층촬영올시행한 중격실장 A 로진단된 현고찰과함께보고하는바이마. 1.000 영의환자들중에서투영 1 3 영의전산화단층촬영소견을운 II. 대상및방법 1980 년 6 윌부터 1980 년 12 월까지 7 개월간에리놀 병원방사선과에서뇌의션산화단층촬영을시행한 1. 00 0 예가운데서투명중격실강으로진단펀 13 예를대상으 로하였다. 이들은 Table 1 에서보는바와같이 4 세에서 74 세까지의광뱀위한연령분포를보였 며낭자가 8 영, 여 자가 5 영이었 ιl 천산화단층촬영운 CGR 제 ND 8.000 scanner 로서 절펀두께는 9mm 이었으며 x- 선속을안와외이강선에 25 의각도로투입촬영하였으며조영후조사 ( postcontrast scan) 은필요애따라수용성조영제안 65 % Angiographin 100 ml 를경정액적주업 ( intravenous drip infusion ) 하였다. m. 결과 Table 1. Age and Sex Distribution Age(yrs) A ale Female Total 1 ~ 9 2 0 2 10 ~ 19 2 3 20 ~ 29 2 30 ~ 39 2 40 ~ 49 0 0 0 50 ~ 59 2 0 2 60~ 2 Total 8 5 13 투명중격실강A로진단펀 13 예 모두에서늘어진상 각형 (elongat ed triangular s hape) 혹은 쐐기형 (wedge shape) 이었으며 발견되는위치는얀와외이 강선에서 25 상방A로그윤선으로부터 :l 6 mm 에서 72mm 사이의양쪽측뇌실이질보이는결펀으로써 모 두마양쪽측뇌실사이에서 CSF 와동일한음영으로 냐타났마 (Fig. 1). 조영후조사를시행한 2 예에서조영후증강이 나타 냐는에는없었다 (Fig.2). Table 1 에서보는바와같이 연령분포는특별한펀 Fig.1. Cavum septum pellucidum; fusiform, elogated triangular. or wedge shape, i sodensit y with CSF on the lateral ventricle, location between ant erior horn of both lateral ventricle is suggested of cavum septum pellucidum ( arrow). -194-
Fig.2. A; precontrast enhancement, reveals cavum septum pel1ucidum and cavum vergae between both lateral ventricle. B; postcontrast enhancement, reveals no contrast enhancement. Fig.3. Combined cavum septum pellucidum and cavum vergae; wedge shape of cavum septum pel1ucidum between both lateral ventricle and posterior extension with rectangular shape of watery density suggesting cavum vergae. 향성응없었으며남자가 8 명여자가 5 명이었다. Ta. ble II 에서보는바외갇이투명중격실강단독 A 로만있 Table ll. Distribution of Cavum Septum Pel. lucidum and Cavum Vergae. only cavum septum pel1ucidum only cavum vergae combined cavum septum peil ucidum and cavum vergae number Total 13 n3 nu i 4 는경우는 9에이었고베르가뇌실 ( cavum vergae) 와동반된경우는 4 예이었으며베르가뇌살단목으로만있는경우는없었마 (F ig.3). 이들 13 에중에서투영중격실강이외에다흔질환이있는경우는 5 예로써이들질환을열거해보연뇌위축이 3 예 (Fig.4), 뇌종양과수두증이동반된경우가 l 예 (Fig.5), 뇌변성이 l 에 (Fig. 6) 이었다. N. 고안 투영중격실강이란투명중격의변형체로써제 5 뇌실 - 195 -
Fig.4. Cavum septum pellucidum and brain atrophy. Fusiform watery Vat tjetween both frontal horn is suggestive of cavum septum pellucidum, and slight ventricular dilatation, promine.nt fissureand cortical sulci witho ut midline shift suggesting brain atrophy. Fig.5. Cavum septum pellucidum and brain tumor and hydrocephalus. Elongated slit like watery Vat zone between both lateral vent ricles is suggestive of cavum septum pellucidum, and i1l defined homogenous 10- wer Vat zone in the brain stem region, posterior displaced deformed fourth ventricle & deformed suprasella cistern, moderate to marked dilatation of third and lateral ventricle suggesting brain tumor and obstructive hydrocephalus_ 1, 2, 3, 4) 이라고도하며뇌실상피로둘러싸여진이중막였다. 이해측연상에서겸상형의공기로채워진공간이 안투명중격사이에수직으로놓여진틈으로서해부학투명중격에의해칼라진틈사이에존재한다. 적경계는천상방으로는뇌량체 (corpus callosum), 베르가뇌실응제 6 뇌실 1, 2, 3, 4 ) 이라고도하며측뇌실 천방경제는슬 (ge nu ), 전상경계는뇌량체와전방교련사이에돌출된중간에위치하는장땅형의낭으로써투 (anterior commis sure) 에의하여형성되는놔량 ( ro- 명중격실강에비해나타냐는빈도는낮 며나타나는경 strum), 하방경계는뇌궁 (fornix) 에의하여이루어진우에는거의대부분투영좋격실강과동반되어나타난다 다. 고한다. 때로양쪽냥시 - 이를가로지르는막이손재하 파거뇌의전산화단층촬영이시행되기천에는뇌의공 는경우도있다고하며양쪽냥음대아기에는거의예 지조영술이냐뇌싶촬영술에의해서만영상화가가능하외없이존재하냐태아가후반기에서낭의뒤쪽부터없 -196-
Fig.6. Cavum septum pellucidum between both lateral ventricles and suggest. ing dege nerative change of the whit e rnàtter of the brain. 어지게되며, 이러한이유로출생시에는에르가뇌실이 대부분없으며조산아에서는양쪽낭이 가많마고한다. 나타냐는경우 사심상투명중격싣캉자체는해부학적쿠초물의 체이냐투명중격에 변형 낭성변화 5) 가생기는경우 Monro 공 의폐쇄를초래하여수두증을야기하는경우 5, 7, 8, 9, 10) 가 있다고하냐저자의경우 13 예모두마에서냥성변화를 볼수없었으며뇌의천산화단층촬영시발견되어지는해 부학척주조물로볼수있었마. 그러고 A. Ronald Cowl ey 5) 씨둥의보고에 의하면 투명중격에낭성변화가있는경우감열해야할질환 A 로써는 flui d fill ed midline cysts 즉 neuroepithelial cysts, Colloid cysts, cysts of cavum velum interpositum, paracytic cysts, craniopharyngioma, the leaves of septum pellucidum 과 갇윤경우들이있다고하였 나저자의경우낭성변화 - 를일으킨정우가없어강옐진단을요하는경우는없었 다. V. 결론 REFERENCES 1. Juan M. Taberas, M.D., Ernest H. Wood, M.D. Diagnostic neuroradiology, second edition, second edition, Vol. 7, 344-346, 7977. 2. David Sutton : A text book of radiology and imag. ing thi 'rd edition, Vol. 1/, 7756, 7980. 3. John Caffey : Pediatrix X.ray diagnosis, seventh edi. tion, Vol. 1, 166. 3. John Caffey : Pediatrix X-ray diagnosis, seventh edi. tion, Vol. 7, 766-774, 7978. 4. Derek C. Harwood-Nash, Charles R. Fitz Neuroradiology in infants and children, Vol. 7, 283-285, 7976. 5. Cowley A. Ronald Distinctive CT appearence of cyst of the cavum septi peμ ucidi, AjR. 733:548-550, 7979. 6. Charles Mayo Goss, A. B., M. D. Gray 's anatomy, twenty-seventh american edition, 856, 7973. 7. Sh unk, H. Congenital dilatation of the septum pellucidum, Radiology. 87:670, 7963. 투영중격실강의진단응비침입성진단방법안뇌의전 8. Lowman R.M., Shapiro R., Collins L. C. : The signi- 산화단층촬영을이용하는것이우수하고중요한진단방 법으로생각되며, 투영중격살강으로진단된총 13 에는 59: 777-796, 7948. ficance of the widened septum pelluci dum, AjR. 영리학적인연에서보마해부학적안연에서그의의를 9. Shaw C.M., Al vord E.C. Cavum septi pellucidi et 찾을수있었고, 전산화단층촬영소견윤양쪽측뇌실 vergae, Brain. 92:2 73-224, 7969. 사이에위치하는측뇌실의뇌척수액과동일한음영의늘 10. Heiskanen O. Cyst of the septum pellucidum 어진상각형혹윤쐐기형의쿠조물이었마 caus ing increased intracranial pressure and hy drocephalus, j. Neurosurg. 38:777-773, 7973, - 197 -