책소개

제 3판을 출간하며

영상의학 입문을 목표로 하는 학생들을 위한 학생들의 기준서가 되기를 바라는 마음으로 개정판을 출간하게 되었다. 지난 10년간 엄청난 지식의 홍수를 경험하였듯이 영상의학의 발전의 발전과 지식의 발생은 그 선두에 있다고 말 할 수 있으며 이러한 변화에 따라서 새롭게 발전하는 영역의 지식을 함께 공유하고 발전시키기 위하여 반드시 익혀야 할 필독서가 되었으면 한다.

학생들 스스로 읽으면서 이해할 수 있도록 내용을 추가하고 보완하였고 영상의학의 방대한 지식들에서 중요하다고 판단하는 부분들을 선별하였으며 도해를 이해하기 쉽게 정리하고 증례 들을 고화질의 최신 사진들로 대치하고 보완하였다.

이 개정판은 연세대학교 의과대학 영상의학교실 전 교수진의 해박한 영상의학 지식을 쉽게 압축하여 제공하므로 의과대학 교육의 지침서로 역할을 다 할 것을 기대하며 그 동안 헌신적인 노력을 기울인 최병욱교수와 전 집필 교수진의 노고에 감사 드립니다.

2012. 9. 1

연세대학교 의과대학 영상의학교실

주임교수 서 진 석

저자 및 역자 소개
강원준 부교수
핵의학
곽진영 부교수
갑상선 영상의학
김경아 조교수
복부 영상의학
김기황 교수
복부 영상의학
김동익 교수
신경 두경부 영상의학
김동준 부교수
신경 두경부 영상의학
김만득 부교수
인터벤션 영상의학
김명준 교수
소아 영상의학
김명진 교수
복부 영상의학
김민정 부교수
유방 갑상선 영상의학
김병문 부교수
신경 두경부 영상의학
김상진 교수
흉부 심장 영상의학
김성준 조교수
근골격 영상의학
김여은 조교수
복부 영상의학
김영진 조교수
흉부 심장 영상의학
김은경 교수
유방 갑상선 영상의학
김정아 부교수
유방 갑상선 영상의학
김주희 부교수
복부 영상의학
김진아 조교수
신경 두경부 영상의학
김태훈 교수
흉부 심장 영상의학
문희정 조교수
유방 갑상선 영상의학
박미숙 부교수
복부 영상의학
박성일 부교수
인터벤션 영상의학
박해정 부교수
의학 영상학
서상현 부교수
신경 두경부 영상의학
서진석 교수
근골격 영상의학
손은주 부교수
유방 갑상선 영상의학
송호택 부교수
근골격 영상의학
안성수 조교수
신경 두경부 영상의학
안지현 조교수
복부 영상의학
오영택 부교수
비뇨기 영상의학
원종윤 교수
인터벤션 영상의학
유영훈 교수
핵의학
유정식 교수
복부 영상의학
육지현 조교수
유방 갑상선 영상의학
윤미진 부교수
핵의학
윤춘식 교수
소아 영상의학
이광훈 부교수
인터벤션 영상의학
이도연 교수
인터벤션 영상의학
이미정 조교수
소아 영상의학
이승구 교수
신경 두경부 영상의학
이영한 조교수
근골격 영상의학
vi 영상의학
前 교실원
김희영 조교수(강원대의대)
흉부 심장 영상의학
김희중 교수(원주 보건과학대학)
의학 영상학, 의학영상 정보학
남지은(메디스캔 검진센터)
흉부 심장 영상의학
박재석 조교수(고려대학교)
자기공명영상물리학
오기근 명예교수
유방 갑상선 영상의학
유형식 교수(건양대의대)
복부 영상의학
이영호 교수(성균관의대)
산과 초음파학
이종태 교수(차의과대학)
인터벤션 영상의학
이종두 교수
핵의학
이재훈 조교수
핵의학
이혜정 조교수
흉부 심장 영상의학
임준석 부교수
복부 영상의학
전태주 부교수
핵의학
정대철 조교수
비뇨기계 영상의학
정수윤 부교수
복부 영상의학
정용은 조교수
복부 영상의학
정재준 교수
복부 영상의학
정태섭 교수
신경 두경부 영상의학
조은석 조교수
복부 영상의학
조응혁 조교수
핵의학
조희우 조교수
근골격 영상의학
최병욱 교수
흉부 심장 영상의학
최진영 부교수
복부 영상의학
허 진 조교수
흉부 심장 영상의학
허용민 부교수
근골격 영상의학
홍유진 조교수
흉부 심장 영상의학
최규옥 교수(건양대의대)
흉부 심장 영상의학
최지수 조교수(국립암센터)
유방 갑상선 영상의학

목차
01 영상의학 물리
I. 방사선 물리 X-선 물리와 진단적 응용 ································································ 1
1. 방사선(radiation) / 1
2. X-선의 발생(X-ray production) / 2
3. 방사선 영상(radiological image) / 4
4. 영상(image) / 4
5. 디지탈 감산 혈관 조영술(digital subtraction angiography; DSA) / 5
6. 정전 잠상영상(electrostatic image : xeroradiography) / 5
7. CR (computed radiography) / 5
8. DR (digital radiography) / 6
II. 전산화 단층촬영술의 원리(CT scan : computed tomography) ······························ 6
III. 방사선생물학(radiobiology) ··········································································· 8
1. 방사선과 물질의 상호작용(방사선의 흡수) / 8
2. 방사선의 영향(생물학적 변화) / 8
3. 방사선에 의한 인체의 위험 / 9
IV. 영상진단영역의 조영제(diagnostic pharmaceuticals : contrast media) ················· 11
1. X-선 발생장치를 위한 조영제 / 11
2. 자기공명영상 조영제 / 13
3. 초음파 도플러검사 조영제 / 14
V. 초음파 검사의 원리 ···················································································· 14
1. 초음파란 무엇인가? / 14
2. 초음파와 물질의 상호작용 / 15
3. 초음파 기기 / 16
4. 도플러 초음파 / 17
5. 초음파 검사의 특징 / 19
VI. 자기 공명 영상의 기초 물리학 ····································································· 20
1. MRI 물리학의 기초 / 20
2. 공명 / 21
3. 인체 안의 물 분자 / 22
4. MR 펄스 대열(pulse sequence) / 22
5. 기초 NMR 물리적 특성 / 24
6. MR이 어떻게 의학에서 쓰이나? / 25
xiii
7. 지방 신호 제거(fat suppression) / 27
8. MR 혈관촬영술(MR angiography; MRA) / 28
9. RF 코일의 역할 / 28
10. MR 실제 / 28
VII. 핵의학 물리 ····························································································· 29
1. 핵의학의 정의 / 29
2. 방사성 동위원소(radioisotope) / 29
3. 방사능(ra dioactivity) / 29
4. 핵의학영상기기의 원리 / 30
5. 방출전산화단층촬영장치(emission computed tomography; ECT) / 32
6. 방사화합물의 조건 / 35
7. 방사 화합물(radiopharmaceutical) / 35
VIII. PACS와 디지털영상 ················································································· 35
1. PACS / 35
2. DICOM 표준 / 37
3. 영상의 획득(image acquisition) / 37
4. 저장 및 기록(storage and archives) / 40
5. 영상압축 / 42
6. 보안(security) / 43
02 흉부 영상의학
1. 총론 45
I. 방사선 검사방법 ·························································································· 45
II. 정상 흉부 방사선 사진의 해부학적 특징 ···························································· 47
III. 흉부 사진 판독의 원칙 ················································································· 52
2. 각론 75
I. 감염성 폐질환 ····························································································· 75
1. 폐렴과 폐농양 / 75
xiv 영상의학
2. 폐결핵 / 76
3. 기타 감염성 폐질환 / 78
II. 폐종양 ····································································································· 78
1. 폐암의 방사선 검사 / 78
2. 세포형에 따른 원발성 폐암의 방사선 소견 / 79
3. 원발성 폐암의 전이 / 80
4. 전이성 폐암 / 81
5. 기타 폐종양 및 유사폐종양(tumor like lesion) / 81
III. 기도 질환(air way disease) ·········································································· 81
1. 급성 기관지염(acute bronchitis) / 81
2. 만성 기관지염(chronic bronchitis) / 82
3. 폐쇄성 세기관지염(bronchiolitis obliterans; BO) / 82
4. 미만성 범기관지염(diffuse panbronchiolitis; DPB) / 83
5. 기관지 확장증(bronchiectasis) / 83
6. 폐기종(pulmonary emphysema) / 83
IV. 직업성, 물리화학적 원인에 의한 질환 ···························································· 83
1. 진폐증(pneumoconiosis) / 83
2. 방사선 폐렴 / 84
3. 화학물질 / 84
V. 순환장애에 의한 폐질환 ·············································································· 85
1. 폐부종 / 85
2. 성인형 호흡곤란 증후군(adult respiratory distress Syndrome; ARDS) / 86
3. 폐혈전 색전증 및 폐경색(pulmonary thromboembolism and infarction) / 87
VI. 간질성 폐질환 및 기타 ················································································ 87
1. 만성 간질성 폐렴(chronic interstitial pneumonia) / 87
2. 교원성 혈관 폐질환(collagen vascular lung disease) / 88
3. 면역 이상에 의한 폐질환 / 88
4. 폐외상 / 89
5. 기타질환 / 90
VII. 종격동 질환 ····························································································· 91
1. 종격동 종양 / 91
2. 선천성 질환 / 91
3. 염증성 질환 / 93
xv
VIII. 늑막질환 ······························································································· 93
1. 늑막삼출 / 93
2. 기흉(Pneumothorax) / 93
3. 늑막 종양 / 93
IX. 횡격막 및 흉벽질환 ··················································································· 94
03 심혈관 영상의학
I. 총 론 ······································································································· 95
1. 방사선 검사 방법 / 95
2. 폐순환의 방사선 소견 / 98
3. 흉부 단순 촬영상 정상 및 심방, 심실 확장 소견 / 101
4. 폐부종의 방사선 소견 / 102
5. 심방 및 심실의 해부적 특징 / 103
II. 후천성 심질환 ·························································································· 103
1. 심막 질환 / 103
2. 판막 질환 / 105
3. 폐성심(cor pulmonale) / 108
4. 고혈압성 심질환 / 108
5. 허혈성 심질환 / 108
6. 심근증(Cardiomyopathy) / 110
III. 선천성 심장병 ·························································································· 112
1. 심실중격결손증(VSD) / 112
2. 심방중격결손증(ASD) / 113
3. 동맥관 개존증(PDA) / 113
4. 방실중격 결손증(atrioventricular septal defect) / 114
5. 폐정맥 환류이상(Anomalous pulmonary venous return) / 114
6. 판막성 폐동맥 협착(valvular pulmonary stenosis) / 116
7. 팔로사징(Tetralogy of Fallot) / 117
8. 대혈관 전위증(transposition of great vessel) / 117
9. 복합 기형 / 119
xvi 영상의학
04 신경 영상의학
1. 뇌신경계 질환 121
I. 영상 진단 방법과 정상 방사선학적 해부 ··························································· 121
1. 단순두개촬영 / 121
2. 초음파진단(ultrasonography)의 이용 / 123
3. 핵의학 영상진단(Nuclear medicine) / 124
4. 전산화단층촬영(computed tomography：CT) / 124
5. 자기공명영상(magnetic resonance imaging：MRI) / 125
6. 뇌혈관 촬영과 중재적시술 / 127
II. 병적 소견의 분석과 감별진단 ······································································· 130
1. 단순두개촬영 / 130
2. 전산화 단층촬영 / 131
III. 뇌출혈과 뇌혈관 질환(Cerebro-vascular Disease) ·········································· 132
1. 두개강내 출혈 / 132
2. 고혈압성 뇌출혈(hypertensive hemorrhage) / 135
3. 뇌경색증(cerebral infarction) / 135
4. 혈관 폐색성 질환(vascular occlusive diseases) / 139
5. 뇌혈관기형(Cerebrovascular malformations) / 141
IV. 뇌 종양 ·································································································· 141
1. 뇌종양의 분류 / 141
2. 뇌종양의 방사선학적 특징 / 142
3. 신경교종(glioma) / 144
3. 기타 뇌종양 / 146
4. Sellar Turcica 주위의 종양 / 150
V. 뇌 염증성 질환 ························································································ 152
1. 세균성 염증(bacterial infections) / 152
2. 그외 감염성 뇌질환 / 154
2. 척추 및 척수질환 156
I. 척추골의 단순 X-선 촬영(plain X-ray of Spine) ·············································· 156
1.척추골의 단순 X-선 촬영법 및 각종 검사법 / 156
xvii
2. 척추골의 단순 X-선상 소견 / 157
3. 척추골의 각종질환 / 158
II. 척추조영촬영술(Myelography) ····································································· 160
III. 척추간판조영(Discography) ········································································ 161
IV. 척수혈관 조영술(spinal cord angiography) ················································· 162
V. 척추 CT (Spine CT scan) ········································································· 162
1. 요추간판탈출증(herniated lumbar disc) / 162
2. 요추 협착증(lumbar spinal stenosis) / 163
VI. 척추 MRI (Spine MRI) ·············································································· 163
1. 척추관 및 척수종양(tumor of the spinal canal and cord) / 163
2. 추간판탈출증(herniated lumbar disc; HLD) / 164
3.퇴행성 추증(degenerative spondylosis) / 165
4. 외상(trauma) / 166
5. 선천성 질환(congenital abnormalities) / 166
6. 원판염 및 골수염(discitis/osteomyelitis) / 166
3. 두경부 질환 166
I. 영상 진단 방법 ·························································································· 166
1. 단순 방사선 촬영 / 166
2. 전산화단층촬영(CT)과 자기공명영상(MRI) / 166
3. 초음파(ultrasonography) / 167
4. 혈관 조영술(angiography) / 167
5. 타액선조영술(sialography) / 167
6. 핵의학 검사 / 167
II. 안와(Orbit) ····························································································· 167
1. 영상 해부 / 167
2. 안구 병변 / 168
3. Intraconal region / 168
4. Conal region / 169
III. 비강과 부비동(Sinonasal cavity) ································································ 169
1. 영상 해부 / 169
2. 부비동염 / 170
xviii 영상의학
3. 양성 종양 / 171
4. 악성 종양 / 171
IV. 측두골(Temporal bone) ··········································································· 171
1. 영상 해부 / 171
2. 이유돌염(otomastoiditis) / 171
3. 후천성 진주종(acquired cholesteatoma) / 172
4. 청신경초종(acoustic schwannoma) / 173
5. 측두골 골절 / 173
V. 인두와 후두 ···························································································· 173
1. 영상 해부 / 173
2. 비인두암 / 174
3. 편도농양 / 174
4. 성대 마비 / 174
VI. 갑상선과 부갑상선 ··················································································· 175
1. 영상 해부 / 175
2. 갑상선 결절 / 175
3. 갑상설관낭(thyroglossal duct cyst) / 175
4. 부갑상선 선종 / 176
VII. 타액선(Salivary gland, 침샘) ···································································· 177
1. 영상 해부 / 177
2. 타액선염 / 178
3. 종양 / 178
05 복부 영상의학
1. 식도 179
I. 정상 식도 ································································································ 179
1. 식도의 정상해부학 / 179
2. 식도의 영상진단 / 179
xix
II. 식도판독의 중요사항 ················································································· 180
1. 식도 구경 / 180
2. 식도 강내 음영결손 / 180
3. 가장자리의 윤곽 / 180
4. 점막 모양 / 180
5. 연동운동(peristalsis) / 180
III. 식도의 운동장애 ···················································································· 180
1. 원발성 식도운동 장애 / 180
2. 이차성 식도운동 장애 / 181
IV. 식도염(esophagitis) ················································································· 182
1. 역류성 식도염(reflux esophagitis) / 182
2. 칸디다 식도염(Candida esophagitis) / 182
3. 부식성 식도염(caustic esophagitis) / 182
4. 식도염의 감별진단 / 183
V. 식도 종양 ······························································································· 183
1. 양성 종양 / 183
2. 악성 종양 / 183
VI. 식도의 기타질환 ····················································································· 186
1. 식도 게실(diverticulum) / 186
2. 식도 정맥류(esophageal varices) / 187
3. 식도 열공 탈장(esophageal hiatal hernia) / 187
2. 위 188
I. 정상 위 ··································································································· 188
1. 위 정상 해부학 / 188
2. 검사 방법 / 188
II. 위염(gastritis) ·························································································· 189
1. 미란성 위염(erosive gastritis) / 189
2. 비후성 위염(hypertrophic gastritis) / 189
3. 메네트리에병(Menetrier’s disease) / 190
III. 위궤양(gastric ulcer) ················································································ 190
xx 영상의학
IV. 위암(gastric carcinoma) ··········································································· 191
1. 진행성 위암(advanced gastric cancer) / 192
2. 조기 위암(early gastric cancer) / 192
3. 위암의 CT 소견 / 192
V. 양성 점막종양 ························································································· 193
1. 과형성성 용종(hyperplastic polyp) / 193
2. 선종성 용종(adenomatous polyp) / 193
3. 용종 증후군(polyposis syndrome) / 193
VI. 점막하 종양(submucosal tumor) ································································ 194
1. 위장관 간질종양(gastrointestinal stromal tumor; GIST) / 194
2. 평활근종(smooth muscle tumor) / 194
3. 신경종(neural tumor) / 194
4. 지방종(lipoma) / 194
5. 혈관종(hemangioma) / 195
VII. 기타 악성종양 ························································································ 195
1. 림프종(lymphoma) / 195
3. 소장 195
I. 소장의 영상진단 ························································································ 195
1. 소장 바륨 조영술 / 195
2. 혈관 조영법 / 195
3. CT / 196
II. 염증성 질환 ····························································································· 196
1. 크론병(Crohn’s disease) / 196
2. 결핵성 장염 / 197
3. Behcet 병 / 197
III. 흡수부전증후군 ························································································ 198
1. 원발성 / 198
2. 이차성 / 198
IV. 소장종양 ······························································································ 198
xxi
4. 대장 199
I. 대장질환의 영상진단 ·················································································· 201
1. 단순 복부 촬영 / 201
2. 대장 조영술 / 201
3. 단면 영상 검사 / 201
4. CT 대장 조영술 / 201
5. 혈관 조영술 및 중재 시술 / 202
II. 염증성 대장질환 ······················································································· 203
1. 대장 조영술 / 203
2. 게실질환 / 204
3. 결핵성 결장염 / 204
4. 크론병(Crohn’s disease) / 205
5. 궤양성 결장염(ulcerative colitis) / 206
6. 허혈성 결장염(ischemic colitis) / 208
III. 대장 용종과 대장암 ··················································································· 208
1. 대장 용종 / 208
2. 대장암 / 210
IV. 대장의 기타 종양 ······················································································ 211
1. 양성 대장 종양 / 211
2. 악성 대장 종양 / 211
5. 간 212
I. 정상해부학 ······························································································ 212
II. 검사방법 ································································································· 214
1. 초음파(ultrasonography; US) / 214
2. 전산화단층촬영(computed tomography; CT) / 215
3. 자기공명영상(magnetic resonance imaging; MRI) / 217
4. 혈관촬영술 / 220
III. 양성 간 종양 ··························································································· 220
1. 간혈관종 / 220
2. 단순 낭종 / 222
3. 그 외의 양성 종양 / 222
xxii 영상의학
IV. 악성 간 종양 ·························································································· 225
1. 간세포암 / 225
2. 간내 담도세포암 / 228
3. 전이암 / 229
IV. 국소적 간 감염증 ····················································································· 232
V. 미만성 간질환 ························································································· 234
1. 지방간 / 234
2. 간경화 / 236
VI. 혈관성 질환 ··························································································· 238
1. Budd-Chiari 증후군 / 238
2. 문맥혈전 / 239
VII. 간 손상 ································································································ 241
6. 비장(지라) 243
7. 담도와 담낭 245
I. 담낭 ······································································································· 245
1. 담석 / 245
2. 담낭염 / 246
3. 과증식성 질환(hyperplastic cholecystosis) / 247
4. 담낭의 신생물 / 248
II. 담도 ······································································································ 249
1. 담도 폐쇄 / 249
2. 담도 폐쇄의 원인 / 249
3. 담도 결석 / 249
4. 담도 종양 / 249
5. 폐쇄성 황달에 대한 진단적 접근 / 251
8. 췌장 253
I. 염증질환 ································································································· 253
1. 급성 췌염(acute pancreatitis) / 253
2. 만성 췌염(chronic pancreatitis) / 253
xxiii
II. 췌종양 ··································································································· 254
1. 췌관상피세포선암(ductal cell adenocarcinoma) / 254
2. 장액성낭선종(serous cystadenoma) / 256
3. 점액성낭성신생물(mucinous cystic neoplasm) / 256
4. 췌관내유두상점액성종양(intraductal papillary mucinous tumor; IPMT) / 256
5. 도세포종(islet cell tumor) / 257
6. 고형성가성유두종양(solid pseudopapillary tumor; SPT) / 258
7. 췌장발아종(pancreaticoblastoma) / 258
9. 복강 및 기타 258
1. 복강의 구조 및 영상기법 / 258
2. 복강, 장간막, 대망 및 복부 외벽 질환 / 259
10. 급성 복증 264
06 산부인과 영상의학
I. 산과계 ···································································································· 269
1. 초음파검사 기계 및 방법 / 269
2. 산전 초음파 검사의 역할 및 검사 시기 / 269
3. 임신 초기의 초음파 검사 / 270
4. 태아 연령과 체중의 측정 / 273
5. 태아 기형의 초음파 진단 / 274
6. 태반, 제대 및 양수의 초음파 검사 / 279
7. 중재적 초음파검사 / 280
8. 전산화단층촬영과 자기 공명 영상의 역할 / 281
II. 부인과계 ································································································· 281
1. 부인과 질환의 영상 진단방법 / 281
2. 자궁 질환 / 284
3. 난소 질환 / 285
4. 골반 염증성 질환(Pelvic inflammatory disease; PID) / 289
xxiv 영상의학
07 비뇨기과 영상의학
I. 비뇨기계 질환에 대한 영상 진단 검사 ····························································· 291
1. 경정맥 요로조영술(Intravenous urography; IVU) / 291
2. 역행성 신우조영술(Retrograde pyelography; RGP) / 292
3. 선행성 신우조영술(Antegrade pyelography; AGP) / 293
4. 배설성 방광요도조영술(Voiding cystourethrography; VCUG) / 293
5. 역행성 요도조영술(Retrograde urethrography) / 293
6. 초음파 검사(Ultrasonography) / 293
7. 전산화단층촬영(Computed tomography; CT) / 294
8. 자기공명영상(Magnetic resonance imaging; MRI) / 295
9. 혈관 조영술(Angiography) / 295
10. 성인에서 관찰되는 선천성 질환 / 296
II. 요로결석 및 신석회화증 ·············································································· 296
1. 요로결석 / 296
2. 신석회화증(Nephrocalcinosis) / 299
III. 폐쇄성 요로질환 ······················································································ 299
IV. 염증성 요로 질환 ···················································································· 301
1. 급성 신장 감염 / 301
2. 만성 신장 감염 / 302
V. 낭성 신 질환 ··························································································· 304
1. 단순 낭종(Simple cyst) / 304
2. 체세포 우성 다낭신(Autosomal dominant polycystic kidney disease) / 304
3. 후천성 낭성 질환(Acquired cystic disease) / 305
4. 신우 주위 낭종(Parapelvic cysts) / 305
VI. 신 요로 종양 ·························································································· 305
1. 신세포암(Renal cell carcinoma) / 305
2. 맥관근육지방종(Angiomyolipoma) / 306
3. 이행상피암(Transitional cell carcinoma) / 306
VII. 외상성 요로질환 ····················································································· 308
xxv
VIII. 남성 생식기 ·························································································· 309
1. 전립선(Prostate) / 309
2. 음낭 및 고환(Scrotum and testes) / 310
IX. 부신 ····································································································· 312
08 인터벤션 영상의학
I. 혈관영상 ································································································· 313
1. 혈관영상 방법 / 313
2. 각종 혈관질환의 영상 / 314
II. 혈관계 중재적 시술 ···················································································· 317
1. 색전술(embolotherapy) / 317
2. 경피경관혈관성형술(percutaneous transluminal angioplasty; PTA), 혈전 용해술
(thrombolysis) / 319
3. 대동맥 인터벤션 시술 / 321
4. 정맥 및 기타 혈관계 인터벤션 시술 / 321
III. 비혈관계 인터벤션 시술 ············································································· 324
1. 일반적 비혈관계 인터벤션 시술 / 324
2. 간담도계 인터벤션 시술(hepatobiliary intervention) / 326
3. 비뇨 생식기의 인터벤션 시술(Urogenital Intervention) / 328
4. 위장관 인터벤션 시술(gastrointestinal intervention) / 328
5. 기타 / 329
09 근 골격계 영상의학
I. 골의 형성, 구조 및 발육 장애 ······································································· 331
1. 골과 관절 구조 / 331
2. 골 성숙 장애 질환(maturation disorder) / 331
3. 골 성숙도 측정 / 332
xxvi 영상의학
II. 외상(trauma) ··························································································· 332
1. 골절에 대한 설명 / 332
2. 골절의 분류 / 333
3. 골 유합 과정 / 335
4. 골절의 치유 방법 / 335
5. 골 유합의 방사선학적 소견(Radiologic evidence of bone union) / 335
6. 골절의 합병증 / 335
7. 개별적인 뼈와 관절의 외상 / 336
III. 골종양 ··································································································· 343
1. 일반적으로 골종양의 감별 진단을 하기 위하여 다음 사항들을 고려하여야 한다. / 343
2. 원발성 골종양(primary bone tumors) / 345
3. 연부조직 종양(soft tissue tumor) / 352
IV. 골의 염증(Infection of bones) ···································································· 353
1. 급성 골수염(acute osteomyelitis) / 353
2. 골 결핵(tuberculosis of bone) / 354
3. 골매독(syphilis of bone) / 354
V. 관절질환(disease of the joint) ···································································· 354
1. 급만성 화농성 관절염(acute and chronic pyogenic arthritis) / 355
2. 결핵성 관절염(tuberculous arthritis) / 355
3. 류마티스성 관절염(rheumatoid arthritis) / 356
4. 연소기 류마티스성 관절염(juvenile rheumatoid arthritis) / 357
5. 강직성 척추염(ankylosing spondylitis, Marie-Strumpell disease) / 358
6. 건선성 관절염(psoriatic arthritis) / 358
7. 라이터 증후군(Reiter syndrome) / 358
8. 퇴행성 관절질환(degenerative joint disease, osteoarthrosis：osteoarthritis) / 359
9. 통풍성 관절염(gouty arthritis) / 359
10. 칼슘 파이로인산염 침착 질환(calcium pyrophosphate dihydrate deposition; CPPD) / 360
11. 칼슘 수화인회석 침착 질환(calcium hydroxyapatite deposition disease) / 360
12. 신경성 관절 질환(neurotrophic arthropathy) / 360
13. 혈우병성 관절염(hemophilic arthropathy) / 360
14. 색소 융모 결절성 활액막염(pigmented villonodular synovitis; PVNS) / 360
15. 관절내 유리체(loose bodies) / 360
VI. 대사성 골질환(metabolic bone disease) ······················································ 360
1. 골다공증(osteoporosis) / 361
xxvii
2. 골연화증(osteomalacia) / 363
3. 부갑상선 항진증(hyperparathyroidism) / 364
VII. 골괴사(osteonecrosis) ············································································· 365
10 소아 영상의학
I. 신생아 및 소아의 영상의학 검사 시 유의 사항 ·················································· 367
II. 신생아 및 소아 흉부 질환 ············································································ 367
1. 신생아 및 소아 흉부 영상 진단의 특징과 정상 소견 / 367
2. 소아 흉부 질환의 진단에 이용되는 방사선 검사 및 적응 질환의 예 / 368
3. 신생아 흉부 질환 / 368
4. 폐렴 / 371
5. 결핵 / 373
6. 기도 및 기관지 질환 / 373
7. 종격동 질환 / 376
8. 폐 종양 및 종괴성 질환 / 377
9. 기타 선천성 질환 / 377
III. 신생아 및 소아 복부 질환 ··········································································· 380
1. 신생아 및 소아 복부 방사선 사진의 특징 / 380
2. 위장관계 / 380
3. 간, 담도, 췌장 질환 / 388
IV. 신생아 및 소아 비뇨생식기계 질환 ······························································· 391
1. 신생아 및 소아 비뇨생식기계 영상 진단의 특징 / 391
2. 선천성 기형 / 392
3. 수신증(hydronephrosis) / 393
4. 요로 감염 및 방광 요관 역류 / 395
5. 낭종성 신 질환(cystic renal disease) / 397
6. 소아 신 종양 / 398
7. 부신 질환 / 400
8. 난소 및 자궁 질환 / 402
xxviii 영상의학
V. 신생아 및 소아 신경계 질환 ········································································ 404
1. 뇌초음파 검사(neurosonography) / 404
2. 두개골(skull) / 409
3. 기타 / 410
4. 척추(spine) / 410
VI. 신생아 및 소아 근골격계 질환 ····································································· 411
1. 신생아의 임신 주수 평가와 소아의 골연령(bone age) 평가 / 411
2. 외상성 병변들 / 411
3. 대사성 골 병변(metabolic bone disease) / 412
4. 염색체 이상으로 인한 질환 / 414
5. 골 이형성증(skeletal dysplasia)과 기타 선천성 질환 / 414
6. 감 염 / 416
7. 종 양 / 416
8. 기타 질환들 / 416
11 유방 영상의학
I. 유방 영상학 정상유방 ················································································· 421
1. 유방조직의 해부와 기본구조 / 421
2. 유방의 생리 / 421
II. 유방암의 역학 ·························································································· 423
III. 유방암의 스크리닝 검사 ············································································· 423
1. 자가진단 / 424
2. 의사의 진찰 / 424
3. 유방촬영술 / 424
4. 유방암 조기검진 지침 / 424
IV. 유방 영상 진단법 ····················································································· 424
V. 각종 유방질환 ························································································· 429
1. 악성 유방질환 / 429
2. 양성유방질환 / 432
3. 림프절 질환 / 433
xxix
I. 총론 ······································································································· 435
1. 핵의학의 정의 / 435
2. 방사화합물(radiopharmaceutical) / 435
3. 방사화합물의 조건 / 435
4. 방사 화합물의 종류 / 435
12 핵의학
II. 내분비계 영상 ·························································································· 436
1. 갑상선 질환의 영상 진단 / 436
2. 부갑상선 스캔(parathyroid scan) / 440
3. 부신 영상(Adrenal gland) / 441
III. 심혈관계 영상 ························································································· 442
1. Radionuclide ventriculogram (RVG) / 442
2. 심근관류 스캔(myocardial perfusion scintigraphy) / 443
IV. 신경계 핵의학 ························································································· 446
1. CSF Imaging / 446
2. 뇌단일광자 및 양전자방출전산화단층촬영
(Single Photon and Positron Emission Computed Tomography) / 447
V. 폐관류 및 폐환기 스캔 ··············································································· 451
1. 폐관류 스캔을 위한 방사 화합물 / 451
2. 폐환기 스캔을 위한 방사화합물 / 452
3. 폐관류 및 환기 스캔(Perfusion & Ventilation scan) / 453
VI. 근골격계의 핵의학 영상진단 ······································································· 454
1. 골스캔(bone scan) / 454
VII. 위장관 핵의학 ························································································ 458
1. 간 스캔(liver scan) / 458
2. 99mTc RBC 스캔 / 458
3. 담도 스캔 / 459
4. 위장 출혈 / 460
5. 멕켈씨 게실 스캔(Meckel’s scan) / 460
xxx 영상의학
VIII. 비뇨기계 핵의학 ···················································································· 461
1. 방사화합물 / 461
2. Renogram / 461
3. 신피질 영상 / 462
4. 고환염전 및 부고환염 / 462
IX. 양전자방출단층촬영술(positron emission tomography) ··································· 463
1. 양전자방출 방사성동위원소 / 463
2. 양전자방출 방사화합물 / 463
3. 종양 PET / 463
4. 심장 PET / 464
5. 뇌 PET / 465
X. 기타 ······································································································ 465
1. 종양학(Oncology) / 465
2. 감 염 / 466
색인 ········································································································· 484
Index ········································································································ 467