Re:modic change(vertebral endplate signal change)

<A href="http://cafe.naver.com/nakminwooridul.cafe?iframe_url=/ArticleRead.nhn%3Farticleid=499">http://cafe.naver.com/nakminwooridul.cafe?iframe_url=/ArticleRead.nhn%3Farticleid=499</A>   modic change는 mri로 환자의 예후를 보는 하나의 도구로 추가될 수 있다. modic change type1은 subchodral edema로 혈관신생, 부종과 관련성이 있어 통증과 직접적으로 관계가 있을 가능성이 많고(48%에서 통증 발생), modic change가 관찰되면 급격하게 endplate는 망가진다.   panic bird..   - modic change는 추간판의 퇴행성변화에 의한 "end plate의 퇴행성 변화" - 추체에 조혈기능을 가진 red marrow가 조혈기능이 없는 yellow marrow로 변화하면서 mri 신호강도가 변화하는 과정 - 이를 modic change라하고  type 1, 2, 3으로 구분   - subchondral edema소견이 보이는 type1 이 보이면 vertebral endplate는 급속도로 type 2, 3로 진행해간다. - 그림참조   <img src="https://t1.daumcdn.net/cfile/cafe/1426ED1C4A2F4D62B1" class="tx-daum-image" style="CLEAR: none; FLOAT: none" actualwidth="694" hspace="1" width="694" vspace="1" border="0" />     modic change type 1 B : modic change type 2 <TABLE style="BORDER-LEFT-COLOR: #ffffff; BORDER-BOTTOM-COLOR: #ffffff; BORDER-TOP-STYLE: none; BORDER-TOP-COLOR: #ffffff; BORDER-RIGHT-STYLE: none; BORDER-LEFT-STYLE: none; BORDER-COLLAPSE: collapse; BORDER-RIGHT-COLOR: #ffffff; BORDER-BOTTOM-STYLE: none" height=71 cellSpacing=0 width=582 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> T1 강조 영상 </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> T2 강조영상 </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> </TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> Type Ⅰ </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> low signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> high signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> subchondral edema </TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> Type Ⅱ </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> high signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> high signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> fatty degeneration </TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> Type Ⅲ </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> low signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> low signal </TD> <TD style="BORDER-RIGHT: #000000 0.12mm solid; PADDING-RIGHT: 1.8mm; BORDER-TOP: #000000 0.12mm solid; PADDING-LEFT: 1.8mm; VERTICAL-ALIGN: middle; BORDER-LEFT: #000000 0.12mm solid; BORDER-BOTTOM: #000000 0.12mm solid; BACKGROUND-COLOR: #ffffff" width=145 height=17> sclerotic change </TD></TR></TBODY></TABLE>   Type 1. end plate에 균열이 생기면서 혈관성 섬유조직으로 대체되면서 mri상에 "물 신호"처럼 보임(T1 - low, T2-high)   <img src="https://t1.daumcdn.net/cfile/cafe/13116E184A02520989" class="tx-daum-image" style="CLEAR: none; FLOAT: none" actualwidth="634" hspace="1" width="634" vspace="1" border="0" />   Type 2. 이번에는 지방성 골수로 대체되면서 fat 신호처럼 보임(T1 - high or iso, T2-high) - hemangioma와 구분해야 함(추체에 생긴 hemangioma는 경계가 분명한 둥근 모양, modic change는 경계불분명하고, 지저분하게 추간판과 평행한 모습)     <img src="https://t1.daumcdn.net/cfile/cafe/114250194A02535177" class="tx-daum-image" style="CLEAR: none; FLOAT: none" actualwidth="507" hspace="1" width="507" vspace="1" border="0" />   Type 3. 인접한 골수에 섬유화와 골경화(sclerosis)로 T1-low, T2-low. ct상에서는 골경화때문에 하얗게 보임