성조숙증 여아의 골반 초음파 검사 소견
Pelvic Ultrasonography Findings in Girls with Precocious Puberty
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목 적:진성 성조숙증 여아의 골반 초음파 검사 결과의 양상을 분석하고, 다른 사춘기 질환으로부터 진성 성조숙증을 감별 진단하는 데 있어 자궁과 난소 측정의 유용성을 평가하고자 하였다. 방 법:8세 전 이차성징의 발생으로 내원하여 성조숙증의 진단과 원인 검사를 시행 받은 여아 74명(역연령 7.8±0.5세, 골연령 9.9±0.8세)의 임상 자료와 검사 결과를 분석하였다. 골반 초음파 검사를 이용하여 자궁 기저부 전후 직경, 자궁 경부 전후 직경, 양쪽 난소의 직경, 평균 난소 면적, 난소내 난포 크기 등을 측정하였다. 진성 성조숙증 군(n=49)과 비전형 유방조기발육증 군(n=25)의 골반 초음파 측정치를 비교, 분석하였다. 결 과: 진성 성조숙증 여아들은 비전형 유방조기발육증 여아들과 비교하여 자궁 기저부 전후 직경(1.05±0.34 vs 0.74± 0.78 cm, P=0.001), 최고 난소 직경(2.13±0.48 vs 1.84±0.74 cm, P=0.048), 평균 난소 면적 (2.31±0.79 vs 1.69±0.71 cm, P=0.002)이 더 높은 측정값을 보였다. 진성 성조숙증의 진단 기준으로 적용하였을 때 자궁 기저부 전후 직경(˃0.9 cm)의 민감도와 특이도는 65.3%, 84%, 최고 난소 직경(˃2.0 cm)의 민감도와 특이도는 55.1%, 76%, 평균 난소 면적(˃2.0 cm2)의 민감도와 특이도는 62.9%, 80%이었다. 결 론: 진성 성조숙증 여아들은 비전형 유방조기발육증 여아들과 비교하여 골반 초음파 검사를 이용한 자궁 및 난소 측정치가 유의하게 높았으나, 민감도와 특이도는 감별 진단에 유용할 만큼 높지 않았다. 골반 초음파 검사는 여아의 진성 성조숙증 진단에 보조적인 검사로 이용될 수 있을 것으로 생각된다.
Abstract
Purpose:We analyzed pelvic ultrasonography (USG) findings in girls with central precocious puberty (CPP) and assessed the role of uterine and ovarian measurements in discriminating between CPP and other pubertal conditions. Methods:Seventy-four girls (chronological age 7.8±0.5 years, bone age 9.9±0.8 years) with precocious pubertal signs were enrolled. Measurements of uterine and ovarian parameters by pelvic USG included antero-posterior diameters of the uterine fundus and cervix, diameter of each ovary, number of follicles, and maximal diameter of the largest follicle. The pelvic USG parameters were compared between girls with CPP (n=49) and girls with atypical premature thelarche (PT) (n=25). Results:Antero-posterior diameter of uterine fundus (1.05±0.34 vs. 0.74±0.78 cm, P=0.001), maximal ovarian diameter (2.13±0.48 vs. 1.84±0.74 cm, P=0.048) and mean ovarian area (2.31±0.79 vs. 1.69±0.71 cm, P=0.002) were significantly greater in girls with CPP than in girls with atypical PT. For the diagnosis of CPP, the sensitivity and specificity of A-P diameter of uterine fundus (˃0.9 cm) was 65.3% and 84.0%, the sensitivity and specificity of maximal ovarian diameter (˃ 2.0 cm) was 55.1% and 76%, and the sensitivity and specificity of mean ovarian area (˃2.0 cm2) was 62.9% and 80.0%. Conclusion:Girls with CPP had significantly higher dimensions of the uterus and ovary measurements compared to girls with atypical PT, but sensitivity and specificity were not high enough to differentiate CPP from atypical PT. Pelvic USG may help the diagnosis of CPP in girls.
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