두통을 호소하는 소아청소년에서 Brain MRI의 유용성
The Effectiveness of Brain MRI in Children and Adolescents with Headache
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목적: 본 연구는 소아 두통 환자들을 두통에 동반된 증상과 징후의 유무와 두통의 지속기간에 따라 각각 두 집단으로 분류하고 비교분석을 통해 뇌 MRI의 임상적 유용성을 평가하고자 한다. 방법: 2012년 1월 1일부터 2016년 12월 31일까지 5년 동안 인제대학교 일산백병원의 외래, 입원실, 응급실을 내원한 만4세이상 14세이하 소아 환자에서 ICD-10 중 두통(R51), 편두통 및 기타 두통 증후군(G43-G44)으로 진료를 받은 1859명을 추출하였으며 이 중 뇌 MRI 를 시행한 304명을 후향적으로 분석하여 결과를 도출하였다. 결과: 전체 304명의 환아 중 11명에서 복수의 MRI 소견을 보여 총316건을 보였으며 185건이 정상(58.5%), 우연히 발견된 이상 소견이74건(23.4%), 병적 이상 소견이 57건(18.0%)이었다. 두통에 동반된증상 또는 징후가 있는 집단의 정상 소견은 동반된 증상 또는 징후가없는 집단에 비해 낮은 비율을 보였으며 우연히 발견된 이상 소견과병적 소견은 더 높은 비율을 보였다. 두 집단의 MRI 소견은 유의한 차이를 보였다(P=0.049). 두통의 지속기간이 3개월 미만인 집단의 뇌MRI 정상 소견은 3개월 이상인 집단에 비해 낮은 비율을 보였으며 우연히 발견된 이상 소견과 병적 소견은 더 높았다. 두 집단의 MRI 소견은 유의한 차이를 보였다(P=0.001). 결론: 소아 및 청소년에서 두통은 흔한 증상으로 많은 아이들이 두통을 주소로 병원에 내원하고 있으며 불필요한 검사는 지양하되 철저한 병력과 신경학적인 검진을 통해 뇌의 기질적 질환을 배제할 수 없는 동반된 증상이나 징후가 있을 경우 뇌 MRI 검사를 진행하는 것이바람직할 것으로 사료된다.
Abstract
Purpose: In this study, the authors classified the pediatric headache patients according to the presence of associated symptoms or signs, and the duration of headache. The purpose of this study is to evaluate the clinical usefulness of brain MRI in pediatric headache. Methods: Total 1859 patients diagnosed with headache, migraine, other headache syndromes were recruited in the patients at the age of 4-14 years who visited Inje University Ilsan Paik Hospital between 2012 and 2016. 216 patients who met the exclusion criteria were excluded. Of total 1643 patients, 304 patients had brain MRI, and the brain MRI results were retrospectively analyzed. Results: The mean age of 304 patients who had brain MRI was 9.4 years. Among the 316 brain MRI results of total 304 patients, the most common finding was normal in 58.5%, followed by incidental findings (23.4%) and pathologic findings (18.0%). The patients group with associated symptoms or signs with headache showed less normal findings, more incidental and pathologic findings than those without associated symptoms or signs. The MRI findings of two groups showed significant difference (P=0.049). The patients group with less than 3 months of headache showed less normal findings, more incidental and pathologic findings than those with more than 3 months of headache. The MRI findings of the two groups showed significant difference (P=0.001). Conclusions: Brain MRI should be performed with careful history taking and neurologic evaluation to rule out the underlying intracranial diseases especially in case of headaches with associated symptoms or signs.
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