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소아청소년 정신의학에서의 뇌영상연구

Brain Imaging Studies in Child & Adolescent Psychiatry

김예니|김붕년
대한신경정신의학회 (Korean Neuropsychiatric Association)|2007.07|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제46권 제4호|pp. 308-323

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참고문헌

키워드

뇌영상·신경발달장애·자폐장애·주의력결핍과잉운동장애·조기발병 정신증.Neuroimaging· Neurodevelopmental psychiatric disorders· ADHD· PDD· Early-onset schizophrenia.
주제분류정신과학

초록

앞으로도 임상가의 자세하고 포괄적인 임상적 면담이 환아의 이해와 평가, 그리고 치료계획의 수립에 가장 중요한 요소로 남아 있게 될 것임에는 틀림이 없으나, 최근 발달하고 있는 뇌 영상 도구를 사용한 검사도, 분명 환아에 대한 이해를 폭 넓게 해줄 것임에는 틀림 없고, 신경 생물학적인 면과 약물 치료와 관련된 면에서 대단히 중요한 정보를 제공해 줄 것으로 기대된다. 지금까지 활발히 연구되고 있는 CT, MRI등 구조 영상도구, SPECT, PET, MRS등 기능적 영상도구 그리고 QEEG, MEG와 같은 신경생리적인 면을 가미한 기능적 영상도구 등도 아직은 소아-청소년 정신의학의 영역에서의 발전단계는 초보적인 것이 사실이다. 미래에는 위의 영상 도구들 중 MRI가 향후 가장 각광 받는 연구 도구가 될 가능성이 높은데, 그것은 첫째, 방사선에 노출될 위험이 없다는 점, 둘째, 자기장의 영향은 어떤 위험과 부작용도 초래하지 않는다는 점. 셋째, 구조적 영상의 해상력이 날로 발전하여, 이제, Fast MRI의 경우에는 마이크로 밀리미터 수준까지 영상화 하여 대뇌 핵들의 영상화 까지 가능하다는 점. 넷째, 대뇌의 기능성을 측정할 수 있는 기능적 자기구조 공명 촬영도구(functional MRI)의 등장으로 구조 영상의 해상력에 기능적 영상까지 포괄할 수 있는 능력을 가출 수 있다는 점 때문이다. 기능적 영상 도구들 중에서는 PET가 비록 고비용, 많은 장비, 방사선 노출이라는 부담은 있으나, 뇌 기능에 대한 정보에 대해서는 가장 특이적이고, 다양한 정보를 생화학적 단계에서 줄 수 있을 것으로 기대되며, 각 신경전달물질에 대한 수용체 연구를 통해, 살아있는 뇌에 대한 병리적 소견을 정확히 국재화시켜, 영상화해 줌으로서, 병태 생리에 대한 이해를 크게 높여 줄 수 있을 것으로 생각되고 다양한 약물의 치료적 작용을 직접적으로 알 수 있게 해 줄 수 있을 것으로 기대된다. SPECT의 경우엔 간편한 기능적 영상도구로 각광을 받게 될 것이라는 전망이다. 현재 시행 가능한 연구는 뇌혈류 연구와 일부 수용체에 대한 연구이다. 그러나, 방법적 용이성과 저렴한 비용, 반복적용이 가능하다는 점 때문에, 약물 치료 효과와 관련된 연구, 인지적 활성화 과제를 주면서 시행 하는 연구 등에 계속 이용 될 것이며, 현재 PET에 비해 떨어지는 해상력 문제도, 지속적인 기술적 발전에 힘입어 많이 개선될 것이라고 기대되고 있다. 실제 10년 전 초기의 단기 카메라 SPECT에 비해 현재의 삼중 카메라 SPECT는 몇 배 이상 해상도가 개선되었다. 신경생리-기능 영상 도구인 QEEG의 경우 사용의 간편성, 경제적인 면, 방사능 노출 등 검사에 따른 위험이 없다는 점, 뇌 기능 변화에 매우 민감하고 다양한 전기적 정보를 준다는 점, 그리고 계속 발전하는 뇌파의 정보 분석 패러다임 때문에 매우 간편한 인스턴트 기능 검사도구로서 적용될 수 있을 것이라는 기대를 받고 있어, 약물의 작용과 관련된 기능 변화의 반복 추적, 병의 경과에 대한 추적, 인지 기능과 관련된 연구 등에 사용될 수 있을 것이라는 전망이다. 그러나 아직 국재화 능력이 떨어지고, 두피에서 받는 전위를 측정하기 때문에 생기는 많은 artifact들, 그리고 너무 다양한 정보를 주기 때문에 정보의 처리과정이 복잡하고, 특이도와 타당도에 문제가 생길 수 있는 점등이 문제로 지적 받고 있어, 이를 해결해 줄 수 있는 새로운 도구인 MEG의 등장이 기대되고 있는 것이다. 이와 같은 기능 및 구조 영상도구를 적절하게 사용한다면 실험적 연구 목적으로서 뿐만 아니라 실제 임상에서의 환아에 대한 신경생물학적-발달학적 이해와 약물 및 정신치료후의 기능변화에 대한 이해 등 ‘살아있는 뇌를 직접 들여다본다’는 본래의 목적으로 사용될 수 있을 것이라고 생각된다.

Abstract

Brain imaging technique in child and adolescent psychiatry is developing at an astonishing speed. Neuroimaging technique in field of psychiatry has yielded many meaningful and significant scientific results. Till 1980's, its application in child & adolescent psychiatry has been somewhat limited by technical and ethical reasons. But recently, there are cascade of neuroimaging studies in the field of child & adolescent psychiatry due to rapid progression in the technical aspect of imaging and confirmation of the safety of human young subjects. In this article, we summarize scientific results in neuroimaging in child & adolescent psychiatric field from early 1990's to date. We described the advantages, disadvantages and application of diverse structural and functional imaging techniques and suggest future prospect about imaging techniques.

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