소아 급성 화농성 고관절염 의증 환자에서 자기공명영상의 유용성
MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children
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목적: 소아에 있어 급성 화농성 고관절염이 의심되는 경우에 정확한 진단과 그에 따른 치료 방법을 결정하는데 있어서 자기공명영상의 유용성과 임상 결과를 평가하고자 하였다. 대상 및 방법: 2003년 3월부터 2007년 5월까지 급성 화농성 고관절염이 의심되어 자기공명영상 검사를 시행한 환아 20명을 대상으로 하였으며 평균 연령은 3년 5개월(10일-14세)이었으며 평균 추시 기간은 2년 2개월(1년-3년 6개월)이었다. 이들 환아에서 시행한 자기공명영상 소견 및 임상적 결과를 후향적으로 분석하였다. 결과: 자기공명영상 소견상 관절 삼출액이 증가가 있었던 예가 17예(85%)였으며, 그 중 골단이나 골간단부의 신호 강도 변화가 있었던 예가 7예, 주변 근육의 신호 강도 변화가 같이 있었던 예가 3예, 연부조직의 농양 형성이 있었던 경우가 1예 있었다. 관절 삼출액 증가 없이 관절 주변 근육내 농양으로 급성 화농성 고관절염과 유사한 임상증상을 일으킨 예가 3예(15%)있었다. 추시 결과 후유증으로 인한 골 변형을 보인 2예를 제외한 18예에서 진단에 유용한 정보를 제공하였다. 결론: 자기공명영상은 급성 화농성 고관절염의 감별 진단 뿐 아니라 주변 연부 조직이나 골 조직으로 확산된 감염 병소에 대한 유용한 정보를 제공해줄 수 있는 유용한 검사법이라 사료된다.
Abstract
Purpose: The purpose of this study is to assess the usefulness of magnetic resonance imaging (MRI) in diagnosis, planning of treatment methods for suspected acute septic arthritis in children, and evaluation of the clinical results of the operations with the help of magnetic resonance imaging as a diagnostic modality. Materials and Methods: Between March 2003 and May 2007, 20 patients suspected of having acute septic arthritis of the hip underwent MRI. The mean age of the patients was 3 years and 5 months (range: 10 days-14years). The average follow-up was 2 years and 2 months (range: 1 year-3 years 6 months). Assessment of MRI findings and final results with recurrence of the infection and post-infectious radiographic sequelae was performed retrospectively. Results: Among the 20 cases, 17 cases(85%) showed joint effusion. Among these 17 cases, accompanying signal changes were observed in the meta-epiphyseal region in seven cases, and accompanying signal changes were observed in surrounding soft tissue in three cases. Accompanying abscess formation was observed in one case. The remaining three cases(15%), which had no joint effusion, showed an intramuscular abscess pocket around the joint, which mimicked septic arthritis. At final follow up, two cases showed unsatisfactory results,with limited joint motion and radiographic sequelae. Conclusion: In children who are suspected of having acute septic arthritis of the hip, MRI can provide useful information about the location and extent of infection and even the differential diagnosis of acute septic arthritis. MRI was considered to be a useful method for diagnosis of suspected acute septic arthritis in children.
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