고령화 사회로 접어들면서 퇴행성 척추질환의 빈도가 높아지고 의료영상의 질이 나날이 발전하면서 척추영상이 환자의 진료에 있어 많은 부분을 차지하고 그 중요성이 증대되고 있다. 이에 따라 척추영상의 교육에 대한 수요가 증대되고 있음을 실감하게 되었다. 척추에 대한 여러 교과서가 출간되어 왔으나 영상의 이용과 해석에 주안점을 둔 경우는 거의 없었다. 이에 통증척추영상의학회에서는거의 모든 척추 질환의 영상 해석과 영상유도하 중재시술 등을 아우르는 포괄적이고 체계적인 척추영상 교과서가 필요하다는데 의견을 모으고 이 분야에 많은 경험을 가지고 계시는 영상의학과, 신경외과, 정형외과의 교수님 들을 저자로 모셔 교과서를 집필하게 되었다.이 책은 총 8 편 23장으로 구성되어 있으며, 척추영상의 기초에서부터 환자면담 및 진찰에 이르는포괄적인 내용으로 이루어져 있다. 각 장마다 첫 부분에는 독자가 꼭 알아두어야 할 중요한 내용을“key point”로 정리해 두었으며, 마지막 부분에는 해당 분야를 이해하는 데 많은 도움이 되는 참고문헌 들을 “key reference”로 정리하였다. 독자들의 이해를 돕기 위해 많은 표, 모식도, 증례영상 들을 삽입하였다.한가지 독자 여러분의 양해를 구할 것은 이 교과서에서는 한글교과서에 합당한 우리글 표기를 원칙으로 하였으나 우리글이 실제 임상에서 널리 사용되는 용어들과 괴리가 있을 수 있다는 우려에서많이 이용되는 원어들은 무리하게 우리글로 바꾸지 않고 그대로 사용하였다는 것이다. 독자 여러분의 이해를 돕기 위한 노력이었음을 이해하여 주시길 부탁 드린다.옥고를 보내주신 32분의 저자 여러분께 깊은 감사를 드리며, 오랜 시간 동안 저자로서 뿐 아니라편찬위원으로써 감수에 많은 시간을 허락하여 주신 여러 교수님 들께는 더욱 특별한 감사의 말씀을드린다. 또한, 교과서 편찬 과정에 여러 도움을 주신 강흥식 통증척추영상의학회 회장님께도 감사의말씀을 드리며, 마지막으로, 좋은 교과서가 태어날 수 있도록 노력을 아끼지 않으신 고려의학 최병진대표, 이창용 부장, 서상석 차장께도 특별한 감사를 드린다.편집인 정태섭
목차
1편
Basics and Congenital Anomalies (척추영상의 기초와 선천성 질환)
Chapter 01. 척추의 영상 해부학 및 영상검사법 / 3
I. Anatomy ······································································································· 4
II. 척추질환의 영상진단방법 ················································································· 21
III. 척추에 관련된 한국의료영상품질관리원의 임상영상검사 검사기준과 내용 ····················· 30
Chapter 02. 척추와 척수의 정상발달 및 선천성 기형 /35
I. 중추신경계와 척추의 발생 ················································································· 36
II. 소아 척추 및 척수의 영상검사 ··········································································· 39
III. 척수의 선천성 기형 ························································································ 41
IV. 두경부 접합부의 질환(Disorders of the Cranio-Cervical Junction) ······························· 51
V. 소아의 퇴행성 추간판 질환 ··············································································· 55
2편
Degenerative Disease (퇴행성 질환)
Chapter 03. 퇴행성 척추질환 / 61
Chapter 04. 척추의 불안정성 / 79
I. Introduction ·································································································· 80
II. Definition ···································································································· 80
III. Functional anatomy and Biomechanics ································································ 80
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IV. 퇴행성 요추간 불안정성(Degenerative lumbar intervertebral nistability) ··········································· 82
V. Imaging evaluation ························································································· 84
VI. Conclusion ·································································································· 89
Chapter 05. 척추 협착증/ 91
I. 서론 ············································································································ 92
II. 분류 ··········································································································· 92
III. 원인 ·········································································································· 92
IV. 임상양상 ···································································································· 98
V. 영상검사 ····································································································· 99
VI. 해부학적 위치에 따른 척추협착증의 분류 ··························································· 102
Chapter 06. 골다공증 – 불충분골절 / 107
I. Introduction ································································································ 108
II. Bone anatomy and physiology ········································································· 108
III. Epidemiology and aetiology ··········································································· 109
IV. Imaging of osteoporosis ················································································ 110
V. Complications ····························································································· 119
VI. Treatment of osteoporosis and treatment monitoring ············································· 125
3편
Trauma (외상)
Chapter 07. 경추 외상 / 129
I. 경두개와 경추의 손상과 관련된 해부학 ································································ 130
II. 경추 외상 ··································································································· 131
III. 영상 검사 ·································································································· 133
IV. 굴곡 손상(Flexion Injuries) ············································································ 137
V. 굴곡-회전 손상(Flexion-Rotation Injuries) ·························································· 140
VI. 신전 손상(Extension Injuries) ·········································································· 140
VII. 과신전 외회전 손상(Hyperextension and Lateral Rotation Injuries) ···························· 142
VIII. 수직 (축방향 부하) 압박 손상 [Vertical (Axial Load) Compression Injuries] ················· 143
IX. 두개경부 손상(Craniocervical Injuries) ······························································· 143
X. 척수 손상과 관통 손상(Spinal Cord Injury and Penetrating Injury) ······························ 147
XI. 경추 염좌와 추간판 손상(Cervical Spine Sprains and Disc Injuries) ···························· 148
S p i n e R a d i o l o g y
Chapter 08. 흉요추 외상 / 151
I. 서론 ·········································································································· 152
II. Fracture classification ···················································································· 153
4편
Space Occupying Lesions of the Spine (공간점유병변)
Chapter 09. 전이암과 골수 질환 / 167
I. Normal Spinal Bone Marrow ············································································ 168
II. Normal Variations of Spinal Bone Marrow and Bone Marrow Reconversion ················· 169
III. Non-malignant Bone Marrow Disorders ···························································· 172
IV. Malignant Bone Marrow Disorders ··································································· 173
V. Spinal Bone Metastasis ·················································································· 177
Chapter 10. 척추체의 원발성 종양 / 183
I. 영상진단의 지표 ··························································································· 184
II. 원발성 양성 골종양별 영상소견 ········································································ 185
III. 원발성 악성 골종양별 영상소견 ······································································· 196
Chapter 11. 척수, 경막내-척수외, 경막외 종양 / 203
I. Epidural Tumors ··························································································· 204
II. Intradural and Extramedullary Tumors ······························································· 205
III. Intramedullary Tumors ················································································· 209
S p i n e R a d i o l o g y
5편
Infection and Inflammation (감염, 염증성 질환)
Chapter 12. 척추체-추간판 염증 / 217
I. 감염성 척추염 ······························································································ 218
II. Spondyloarthropathy ···················································································· 232
Chapter 13. 척수의 염증과 비종양성 병변 / 245
I. Imaging techniques in spinal cord ····································································· 246
II. Disease involving spinal cord ·········································································· 247
III. 그 외 척수염과 감별을 요하는 질환들 ································································ 261
IV. Summary ·································································································· 265
6편
Image guided spine intervention (영상 유도하 척추 시술)
Chapter 14. 척추 압박 골절에 대한 보강 시술 / 269
I. 경피적 척추성형술(Percutaneous Vertebroplasty) ··················································· 270
II. 풍선척추성형술(Kyphoplasty) ········································································· 281
III. 기타 ········································································································ 283
Chapter 15. 경막외 스테로이드 주사요법 / 285
I. 서론 및 해부학 ····························································································· 286
II. 작용 기전 ··································································································· 287
III. 적응증과 금기증 ························································································· 287
IV. 기구 및 주사체 ··························································································· 288
V. 기법 ········································································································· 288
VI. 합병증 ····································································································· 298
VII. Guideline for epidural injection ······································································ 298
S p i n e R a d i o l o g y
VIII. Facet joint injection ···················································································· 298
Chapter 16. 기타 척추중재시술 / 303
I. 통증유발성 추간판 조영술(Provocative Discography) ·············································· 304
II. 영상 유도 척추 생검(Image-guided Spine Biopsy) ················································· 312
7편
Miscellaneous (기타 질환)
Chapter 17. 척수의 혈관성 질환 : 영상, 진단 및 치료 / 323
I. 척수의 혈류 공급 ·························································································· 324
II. 척수 허혈(ischemia) 및 경색(infarction) ······························································ 325
III. 동정맥기형(Arteriovenous malformation) ··························································· 325
Chapter 18. 수술 후 척추영상 / 333
I. 척추 수술의 기법과 기구들 ·············································································· 334
II. 수술 후 척추 영상기법 ··················································································· 337
III. 수술 후 정상 척추영상 ·················································································· 339
IV. 척추 수술 후 증후군(Failed back Surgery Syndrome, FBSS)· ························································ 341
Chapter 19. 척추측만증 / 353
I. 측만증의 생역학 ··························································································· 354
II. 원인에 따른 측만증의 분류 ············································································· 354
III. 측만증의 영상에 이용되는 용어와 측정법들 ························································ 355
IV. 특발성 측만증(Idiopathic Scoliosis) ·································································· 357
V. 전산화 단층촬영과 자기공명영상의 이용 ····························································· 360
VI. 척추측만증의 기본치료 원칙 ··········································································· 362
S p i n e R a d i o l o g y
Chapter 20. 척수공동증과 척수액 역동 / 365
I. 서론 ·········································································································· 366
II. 뇌척수액의 기능과 생리학 ·············································································· 366
III. 뇌척수액 유체동력학(CSF hydrodynamics) and 뇌척수액 유동 관련 효과
(CSF flow-related effects) ············································································· 366
IV. 뇌척수액 유체동력함 검사를 위한 MR techniques ················································· 369
V. 척수공동증에서의 뇌척수액 유체동력학 ······························································ 371
Chapter 21. 상완신경총의 영상진단 / 373
I. 서론 ·········································································································· 374
II. 정상 영상해부학과 기능 ················································································· 374
III. Brachial Plexus의 질환과 영상소견 ··································································· 376
IV. Brachial plexus에서 MR 확산강조 영상의 역할 ····················································· 384
8편
Patient Interview and Physical Examination
(환자면담 및 진찰)
Chapter 22. 경추 질환에서의 환자 면담 및 진찰 ···································· 389
I. 환자 면담과 진찰(Patient interview and Physical examination) ··································· 390
Chapter 23. 요추 질환에서의 환자 면담 및 진찰 ···································· 397
I. 환자 면담(Patient interview) ············································································· 398
II. 진찰(Physical examination) ············································································· 399
