Journ al of the Korean Radiological Society 1996: 35(6) ’ 949 - 955

CT Findings of Ovarian Teratomas: Mature versus Immature'

Jong Chul Kim, M.D., Young Wol Kim, M.D.

Purpose : To differentiate mature and immature ovarian teratomas, using CT findings. Materials and Methods : The CT findings of ten mature ovarian teratomas (in one patient, bilateral) and ten which were immature were compared, using stat­ istical analysis. Images were evaluated for size, margins, architecture, contents (mural nodules, fat, calcification), septa, local invasion and distant metastasis. These findings were compared with pathologic findings. Results : Of the ten mature tumors, nine were well defined and predominantly cystic in internal architecture, and one was mixed. Mural nodules were found in six tumors, fat in all, distinct calcification in seven, and regular septa in three lesions. Of the ten immature tumors, eight had irregular margins. Seven were predominantly solid in internal architecture and irregularly enhanced, two were mixed, and one was mainly cystic. Fat was detected in five lesions, indistinct scat­ tered calcification in six, irregular septa in three, and local invasion or distant metastasis i n four patients. Conclusion : Compared with mature ovarian teratomas, those that are imma­ ture tend to show CT findings of marginal irregularity, solid mass with irregular enhancement, scattered indistinct calcifications, septal irregularity, local in­ vasion or distant metastasis. Our experience suggests that these findings may be helpful in differentiation of mature and immature ovarian teratomas.

Index Words : Ovary, neoplasms Ovary, CT Teratoma

In patients aged less than 21 , the majority of ovarian surgical resection (4). Immature teratomas are treated tumors are of germ celi origin, and of these more than surgicaliy and with multiagent chemotherapy. It is im­ 40 % are malignant. Of many kinds of germ celi tumors, portant to distinguish a benign mature teratoma from only mature teratomas, which are almost always cystic, one that is immature, since due to the frequent invasion are benign (1). Teratomas are benign or malignant of surrounding structures the latter cannot be com­ neoplasms that are derived from primordial germ celis pletely excised (5). and can arise in the gonads or in extragonadal Ultrasonography is useful in detecting ovarian locations. They are most common in the sacroco­ teratomas, but typical sonographic features are found ccygeal region , while the ovary is the next most fre­ in less than 50 % of lesions (6, 7l. CTfindings character­ quent primary site (2, 3) istic of teratomas (i.e. fat or fat and calcification) have Mature cystic teratomas make up approximately 25 been reported in 65 % of lesions (8, 9). There have, % of all ovarian neoplasms, and are usualiy treated by however, been only a few reports which differentiate mature and immature teratomas on CT findings (1 이 The purpose of this study is to differentiate mature 'Department 01 Diagnostic Radiology , Chungnam National University School 01 Medici ne and immature ovarian teratomas, using CT findings. Received July23. 1996: Accepted September 24 , 1996 Address reprint requests to: Jong Chul Kim , M. 0. , Department 01 Diagnostic MATERIALSand METHODS Radiology , Chungnam National Un iversity School 이 M edi c ine ， ; 640 Daesa.dong , Jung-ku , Taejeon , 301-040 , Korea TeI82.42.220.7835 , Fax 82-42-253-0061 The CT findings of nine patients with mature ovarian -949 - Journ al of th e Korean Radiologi cal Society 1996 : 35 (6) : 949-955 teratomas (in one case, bilateral) and ten with those components) , and mixed (10-50 % softtissuecompon­ which were immature were retrospectively reviewed ents). Local invasion on CT was based on the presence and com pared. Between 1984 and 1996, all 20 teratom­ of tumor infiltration into the fat planes around the mass as were surgically resected and pathologically proven. or encasement of vessels. Findings related to the abov­ The age of the patients ranged from two months to 32 e radiologic criteria were analyzed by two radiologists, years (mean, 16 years). In addition to CT findings, tum­ who reached a consensus. or markers [serum α-fetoprotein (FP) and human chori­ CT and pathologic findings were compared. The onic gonadotropin (HCG)] in each patient were also re­ chi-square test and Fisher’s exact test were used to viewed. evaluate the significance of CT findings in the differen­ CT was performed with a GE 8800 or GE Advantage tial diagnosis of mature and immature ovarian teratom­ High Speed (General Electric Medical Systems, Mil­ as. waukee, Wisconsin , USA) ; continuous precontrast and postcontrast scans from the symphysis pubis to the il­ RESULTS iac crest were obtained at 8 or 1 Omm intervals, with 5 mm slice thickness, during shallow breathing or sus­ Mature teratomas were found in patients aged be­ pended expiration. tween 15 to 32 years (mean , 22) , while immature ter­ Images were evaluated for the CD size, (g) margins atomas were found in those aged between two months (smooth , well defined versus irregular, ill defined), @ and 14 years (mean, 10 years). Thus patients with ma­ internal architecture (cystic, sOlid , or mixed, according ture ovarian teratomas were older than those with im­ to the percentage of low attenuation or soft tissue com­ mature tumors (P=0.0002). Five of ten immature ter­ ponents) , @ contents (mural nod 비 es ， fat, the shape atomas (50 %) had elevated α- FP levels, but, all mature and location of calcifications) , @ septa in multilocular teratomas had normallevels oftumor markers mass (regular, even, thin septum of less than 3mm in The comparative CT findings of mature and imma­ thickness versus irregular, uneven , thick septum of ture ovarian teratomas are summarized in Table 1. more than 3mm in thickness) , @ local invasion, and (j) Their largest diameters ranged from 3. 5 to 20 cm; even distant metastasis. Low attenuation cystic components though the mean diameter of immature teratomas was were defined as areas having CT attenuation values greater than that of mature teratomas, there was no ranging from 10 to 20 Hounsfield units, whereas softtis­ statistically significant difference in size between ma­ sue components had densities equal to muscle densit­ ture and immature lesions. Tumor margins were smoot­ ies. Based on internal consistency, tumors were classi­ h and well defined in eleven lesions (Fig. 1, 2, 3) , and ir­ fied as cystic (Iess than 10 % soft tissue components of regular and ill defined in nine (Fig. 4) . Nine tumors (81 .8 whole tumor volume) , solid (more than 50 % soft tissue %) with smooth margins were mature and two (18.2

a b Fig. 1 . Contrast enhanced CT scan s of bilateral multilocular mature teratomas. a. CT scan through th e mid-pelvis shows a large multilocular cystic mass with smooth well defined margin. It contai ns multiple distinct and di screte calcifi cations in mural nodul es and hypodense fatty areas (white arrows). The septa are thin and regular (black arrow­ head s) b. CT scan at a lower level demonstrates a multiseptated cystic mass with fat and cal cifications in mural nodules (black arrowhead) Th ere is anoth er sm all cystic mass with somewhat irregular margin and mural nodules (white ar rows) in the right side of the uterus (UT). Th e resected specimens showed a large mature multilocular cystic teratoma in the left ovary and a small dermoid cyst in the right 。v ary ， which contained primaril y serous f1 uid , sebum and small mural nodules with fat and calcifications.

950 Jong Chul Kim, et al ’ CT Findings of Ovarian Teratomas

.... ‘ ’ Fig. 2 . Contrast enhanced CT scan of a mature cystic teratoma. Fig. 3. Contrast enhanced CT scan of a benign mature teratoma CT scan through the upper pelvis demonstrates a well defined CT scan through the mid-pelvis demonstrates a well defined, cystic mass with m 비 tiple mural nodules in the posterior wall multilocular cystic mass with calcification in a mural nodule in (arrows) in the right side of the pelvis. The CT number of the in- the posterior wall , mulberry shaped solid portions attached to the ner homogeneous hypodense content was -40 H.U. Pathologic left lateral wall (white arrow), and hypodense fatty content in the specimen revealed a dermoid cyst containing sebaceous fluid left side of the pelvic cavity. The inner septa are linear, thin , and and hairs in the right ovary. regular in thickness (black arrowheads). Pathologic examination revealed a left ovarian mature teratoma composed of sebum, calci fication and hair

a b Fig. 4 . Contrast enhanced CT scans of a large multilocular immature teratoma a. CT scan through the mid-pelvis shows a large multilocular cystic and solid mass with somewhat irregular posterior margin, occupy­ ing the entire pelvis. It contains multiple irregularly enhanced solid portions, some scattered small calcific foci (arrowheads), and sev- eral tiny hypodense fatty areas. The septa are thick and irregular b. CT scan at a lower level demonstrates a multiseptated cystic and sol id mass with hypodense fat, and i rregularly enhanced soft tissue scattered through the posterior two third portions of the mass. The margins of this mass were irregular except the anterior cystic portion. The resected specimen showed a large immature teratoma of multilocular mi xed nature in the right ovary with immature elements, tiny cyst, fat and calcifications. Pathology revealed extraovarian local soft tissue invasion of this grade 1 immature tera­ toma

%) were immature. Eighttumors (88.9 %) with irregular 90 % soft tissue content (Fig. 5 , 6a). A complex mixed margins were immature and one was mature (P=O. mass with 10-50 % soft tissue content was seen in three 00548) of 20 cases (15 %) ; the soft tissue content was 40 % in A cystic mass with predominantly f luid and less than one mature lesion (Fig. 3) , and 45-50 % in two immature 10 % soft tissue content was seen in ten of 20 cases (50 lesions (Fig. 4). Nine cystic lesions and one mixed %) (Fig. 1 , 2) ; a predominantly solid mass with more lesion were mature. AII seven solid soft tissue lesions than 50 % soft tissue content was seen in seven of 20 were immature (Fig. 5 , 6a) (P=0.001). cases (35 %). Six of these seven lesions had more than Mural nodules containing soft tissue, fat or calcifi- - 951 - Journal of the Korean Radiological Society 1996 : 35(6) : 949-955 cations were seen only in six mature teratomas (Fig 1 -3) (P=0.044). Fifteen of 20 lesions (75 %) contained areas of fat on CT ; these fatty areas accounted for most of the tumor content in three cases (Fig. 2) , appeared as small irregular foci in ten cases (Fig. 1, 4, 5, 6a) , and as fat-fluid level in two. Of these lesions, ten were mature and five were immature. Calcifications were detected by CT in 13 of 20 cases (65%) i.e. seven mature teratomas and six which were immature. The shape of calcifications was distinct with sharp margins in six of seven mature tumors (85.7 %), and small and indistinct in four of six immature tumors (66.7 %) (P=0.053). * Calcifications in dermoid cysts were located in mural nodules (Fig. 1, 3) , while calcifications in immature “ / teratomas were scattered throughout the tumors (Fig. Fig. 5. Contrast enhanced CT scan 01 an immature teratoma 4,6a) CT scan through the mid-pelvis demonstrates a relatively well Seven of 20 tumors (35 %) were multilocular lesions delined huge solid mass with multiple irregularly enhanced areas and small loci 01 lat density (arrowhead). Pathologic speci­ withm 비 tiple septa (Fig. 1, 4, 6a). AII septa in three ma­ men revealed a right ovarian immature teratoma 01 grade 11 , ture multilocular tumors were regular (Fig. 1), but the containing numerous primitive neuroepithelial elements, lat, and septa in three of four immature tumors (75%) were ir­ microscopic calcilications regular (Fig. 4, 6a) (P=0.143) . Local infiltration and dis­ tant metastases were seen in four of ten immature tumors (40 %) (Fig. 6) Table 1. Comparison 01 CT Findings 01 Mature and Immature In all patients, CT findings correlated relatively well Ovarian Teratomas with gross pathologicfindings Mature Immature CTFindings DISCUSSION (n =1 이 (n=1 이 Bilaterality 0 Teratomas are classified histologically into mature 3.5-15 5-20 Size(mean) (benign), immature (malignant), and monodermal or (5.5cm) (8.9cm) highly specialized (struma ovarii and carcinoid) types Margin (11 , 12) Smooth , well delined 9 2 The mature teratoma is a benign tumor composed of Irregular, ill delined 8 tissues foreign to the anatomic site in which they arise Internal architecture and usually contains tissues from at least two germ cell Cystic 9 layers. In 90 % of cases, tissues from all three germ cell Solid layers are seen (6). Benign mature teratomas are o 7 either cystic or solid. Mature cystic teratomas, usually Mixed 2 known as dermoid cysts, make up 20-25 % of all ovarian Contents 6 Mural nodule 0 neoplasms (4, 11), and 95 % of ovarian germ cell m tumors (13) . Unlike other germ cell tumors, they can be Fat 5 7 encountered at any age (4). The' cystic component is Calcilication 6 6 usuallya greasy liquid, composed of keratin , sebum, Distinct with sharp marg in 2 에 and hair surrounded by a firm caps 비 e of varying thick­ (I n mural nodule) (0) 1 ness. This tumor is usually unilocular (11) , but may be Indistinct, small and scattered 4 3 multilocular, divided by septa into a number ‘ of Septum 4 3 compartments (14). The mature solid teratoma has a Regular 0 predominantly solid gross appearance (11 , 15) , but Irregular 3 multiple small cystic areas are also present. These 0 Local invasion 3 rare neoplasms occur in young women, predominantly 0 Distant metastasis in the second decade (11). The prognosis is excellent, even if peritoneal implants are present (16). Mature teratomas may have undergone malignant transform­ embryonal and adult tissue derived from all three germ ation. The most common malignant change in a mature celllayers (1 1). They are usually predominantly solid, cystic teratoma is squamous cell carcinoma, followed but numerous cysts of varying size are also seen , and by carcinoid tumor and adenocarcinoma (11). occasionally they can be entirely cystic (1). They occur The immature teratoma is composed of a mixture of most commonly in children and young adults (4, 13)

%4이 Jong Chul Kim, et al : CT Findin gs 01 Ovarian Teratom as

who are on average aged 11 years (17). The prognosis either serous or sebaceous. With contrast media injec­ depends a great deal on the nature and amount of em ­ tion , most of immature teratomas (70 %) were seen to bryonal component especially of primitive neuroec­ be irregularly enhanced (P =0.001). Immature terato­ toderm (18). They are typically not associated with el­ mas tend to be more sol id than those that are mature. It evated serum HCG levels (19) , but in a review ofthe re­ may be difficult to differentiate a benign solid teratoma cent literature, 50% of these tumors had elevated αFP from an immature teratoma, though , fortunately, ma­ levels (2 이 In ou r study, five of ten immature teratomas ture sol id teratom as are rare (11). (50 %) had elevated α FP levels. In our study, mural nodules were found on CT only in Mature teratomas are usually treated by surgical re­ mature teratomas (six of 20) (P=0.044) , similar to the section (4) , and immature teratomas are treated result of Quillin et al. (1 이 Within the ovarian dermoid surgically and with multiagent chemotherapy (5 , 21 , cyst, there may be a protuberance arising from its wall 22). Due to the frequent invasion of surrounding and projecting into its cavity. It is composed of a small structures, immature teratomas frequently cannot be nodule or a round, elevated mass, and soft tissue completely excised (5). There has been some sugges­ prominence may be single or multiple. It has been tion that immature teratomas recur more frequently called Rokitansky’s protuberance, dermoid nipple, than mature teratomas and that recurrent tumors are dermoid protuberance, or dermoid mamilla (11) . The more likely to bemalignant(6). ltis therefore con­ presence of mural nodules favors the diagnosis of ma­ sidered important that mature and immature teratomas ture ovarian dermoid cyst. are preoperatively distinguished on CT. In 75 % of the cases in our study, tumors were seen In our study, mature and immature teratomas were \ on CT to contain fatty components, an incidence similar not significantly different in size. Mass size was not, to that of Friedman et al. (9) , but lower than the figures therefore, a reliable indicator of whether a tumor was of 93-96 % found by Buy et al (8). Even though, in our mature or immature study, fat was more frequently detected in mature In our study, tumor margins tend to be smooth and lesions (100 % ) than in immature lesions (50 %), the regular in mature teratomas (90 %), and irregular and percentage of fat in a tumor was not a useful indicator ill defined in immature tumors (80 %) (P=0.00548) whether a teratoma was mature or immature Tumor margin may thus be a helpf 비 indicator in the dif­ In our study, calcifications (teeth , spiculate, amorph­ ferentiation of mature and immature tumors. ous, punctate, etc.) were found with similar frequency Most of mature teratomas in our study (90 % ) were in both mature and immature tumors. Calcifications cystic; the one exception was both cystic and solid. On were, though, more indistinct and smaller in immature pathologic study, cystic contents were found to be than mature tumors (P=0.053). Calcifications of dermo-

a b Fig . 6. Contrast enhanced CTscans 01 an immature teratoma a. CT scan through the upper abdomen demonstrates an ill defin ed, huge, solid mass with multiple irregularly enhanced soft tissue areas , scattered high densities suggesting indistinct calcifications (arrowheads) , several foci of hypodense latty tissues and curvi­ linear irregular septa (arrows). Pathologic specimen revealed an immature teratoma of grade [[[ in the right ovary , containing numer­ 。 us primitive neuroepithelial el ements , fat , calcifications , bone , cartilage , multiple small cysts and septa b. CT scan through the mid-pelvis shows irregularly enhanced, dirty, curvilinear densities in the mesentery (arrows ). These findings are compatible with tumor in filtration into mesentery. The operative findings revealed multiple, fine , irregular infiltrative nodules in broad ligament, mesentery , peritoneum , posterior of the uterus , and sigmoid mesocolon. The pathologic exam inati on con firmed tum or inliltration into all these areas

- 953 - Journal of the Korean Radiological Society 1996 ; 35 (6) : 949 - 955

id cysts were located in mural nodules in five of six cas­ ed. Pediatric oncology. 1st ed. Philadelphia : JB Li ppincott, 1989 es (83.3 %) , while calcifications in immature teratomas 713-731 were scattered throughout the tumors (100 %). Fried­ 4. Talerman A. Germ cell tumors of the ovary. In Kurman RJ , ed man et al. (9) reported calcification and teeth in the der­ Blaustein’s pathology of the female genital tract. New York , NY Springer-Verlag , 1987:660-721 moid plug on CT. Calcifications can be seen in imma­ 5. Sisler CL , Siegel MJ. Ovarian teratomas : a comparison 01 the ture teratomas because of the almost invariable as­ sonographic appearance in prepubertal and postpubertal girls sociation with mature teratomas. Although calcifica­ AJR1990 ; 154 : 139-141 tions may, in the former , represent teeth , they are more 6. Keslar P, Bu ck JL. Germ cell tumors olthe sacrococcygeal region commonly fragments of calcified carti lage or bone (1), radiolog ic-pathologic correlation. RadioGraphics 1994; 14 and can therefore be more irregular in these teratom­ 607-620 as. The location and morphology of calcifications may 7. Sheth S, Fishman EK , Buck JL , Hamper UM , Sanders RC. Thevar­ be helpf비 in the differentiation of mature and immature iable sonographic appearance 01 ovarian teratomas : correlation tumors with CT. AJR 1988; 151 : 331-355 The mature tumor is usually unilocular but may be 8. Buy JN , Ghossain MA , Moss AA , et al. Cystic teratoma olthe ovar­ multilocular, divided by septa into a number ofcompar­ y: CT detection. Radiology 1989; 171 :697-701 9. Friedman AC , Pyatt RS , Hartman DS , Downey EF Jr, Olson WB. CT tments (13). Rosai (11) reported that 88 % of his cases 。 1 benign cystic teratomas. AJR 1982; 138 : 659-665 was unilocular. Benign teratomas in our study were 10. Quillin SP , Siegel MJ. CT leatures 01 benign and malignant ter­ unilocular in 70 % of cases. Septa in the tumors were atomas in children. JComput AssistTomogr 1992 ; 16(5) : 722-726 found in seven of 20 cases, without a significant differ­ 11. Rosai J. Female reproductive system. In Rosai J, ed. Ackerman’s ence in incidence between mature and immature tum­ surgical pathology. 8th ed. St. Louis: Mosby, 1996; 1499-1502 ors. In immature teratomas, however, the septa were 12. Cotran RS , Kumar V, Robbins SL. Female genital tract. In Cotran more irregular in thickness and shape and more stron­ RS , Kumar V, Robbins , SL , eds. Robbins pathologic basis of dis­ gly enhanced (three of four cases) than those which ease, 4th ed. Philadelphia : W. B. Saunders 1989 : 1127-1180 were mature (none of three) (P=0.143) , though the dif­ 13. Jones, HW 11 1. Germ cell tumors 01 the ovary. In Scott JR , DiSaia ference was not statistically significant PJ , Hammond CB , Spellacy WN , eds. Danforth ’s obstetrics and In our study, tumor margin , internal architecture and gynecology. 6th ed. Philadelphia : JB Li ppincott, 1990 : 831-848 14. Yamashita Y, Hatanaka Y, Torashima M, Takahashi M, Miyazaki the mural nodule were found to be very helpf 비 in the dif­ K, Okamura H. Mature cystic teratomas olthe ovary without lat in ferentiation of mature and immature ovarian teratom- the cystic cavity:MR leatures in 12 cases. AJR 1994;163 as. 613-616 In conclusion , immature ovarian teratomas tend t 。 15. Kawakami S, Togashi K, Egawa H, et al. Solid mature teratoma 01 show CT findings of marginal irregularity, solid mass the ovary: appearance at MR imaging. Comput Med Imag Graph with irregular enhancement, septal irregularity, tiny in­ 1994; 18(3) : 203-207 distinct and scattered calcifications, local invasion or 16. Benirschke K, Easterday C, Abramson D. Malignant solid tera­ distant metastasis, compared with mature teratomas. toma 01 the ovary. report 01 three cases. Obstet Gyneco/1960 ; 15 Even though these findings are not determinant, they 512-521 may be helpf비 in the differentiation of an mature and 17. Phelan E. Gynecology and intersex. In Carty H, Shaw D, Brunelle immature ovarian teratoma, especially when they are F, Kendall B, eds. Imaging children. 1st ed. Edinburgh : Churchill Li vingstone, 1994 :773-775 considered in conjunction with serum α -FP level and 18. Beilby JOW, Parkinson C. Features 01 prognostic signilicance in the patient age. solid ovarian teratoma. Cancer 1975; 36: 2147-2159 19. Norris HJ , Zirkin HJ , Benson WL. Immature (malignant) teratoma REFERENCES 01 the ovary. a clinical and pathologic study 0158 cases. Cancer 1976; 37 : 2359-2372 1. Moser , R.P. Malignant germ ce ll tumors 01 the ovary. Radi- 20. Gallion H, v

- 954 Jong Chul Kim, et al : CT Findings of Ovarian Teratomas

대 한방사섣의 학회 지 1996: 35(6) : 949 - 955

난소 기형종의 CT 소견 : 성숙형과 미숙형의 감별 1

I 충남대학교 의과대학 진단방사선과학교실

김종철·김영월

목 적 성숙형과 미숙형의 난소 기형종을 CT 소견으로 감별하고자 함.

대상 및 방법 · 성숙형 10 여 1 ( 1 명은 양측성)와 미축형 10 여|의 난소 기형종의 CT 소견을 종앙의 크기， 윤곽， 내 부 구조， 성 분 (지방， 석회화， 벽 결절)， 격막， 국소 침습과 원격 전이에 대해 분석한 후， 병리 소견과 비교하였다.

결 과 : 성숙형 종앙 10 예 중 9여|의 윤곽이 염확하였다. 내부 구조로 볼 때 9 예는 낭성 종괴이었고， 한 예는 혼합 종양이었 다. 벽 걸절은 6 예， 지방은 10 예， 뚜렷한 석회화는 7 예， 그리고 규칙적인 격막은 3예에서 관잘되었다. 미숙형，종앙 10 예 중 8 예 의 윤곽이 불규칙하였다. 내부 구초로 볼 때 불규칙하게 조영 증강되늠 고형 종괴가 7 예， 흔합형이 2 예， 그리고 낭성 종괴가 1 예이었다. 지방은 5 여 1 ， 산재된 석회화는 6 예， 불규칙한 격막이 3여 1 ， 국소 침습과 원격 전이가 4 예에서 보였다.

결 론 : 성숙형에 비 해 미숙형 난소 기형종은 CT상 그 윤곽 및 격 막이 더 불규칙하고， 불규칙하게 조영 증강되는 고형 성

분이 많고， 석회화가 불분명하게 산재되어 있으며， 국소 침습이나 원격 전이가 많았다. 상기의 소견은 난소의 성숙형과 미숙

형 기형종을 감별하늠 데 도움을 줄 수 있을 것으로 사료된다.

955 - 《 저작권에 관한 동의서 》

라는제목의 논문이 대한방사선의학회지에 출간될 경우그저작권을대한방사선의학회에 이전한다. 저자는 저작권이외의 모든권한즉， 특허신청이나 향후논문을 작성하는데 있어서 본논문의 일부 혹은 전부를 사용하는 등의 권한을 소유한다. 저자는 대한방사션의학회지로부터 서면허가를 받으면 타논문에 본논문의 자료를 사용할 수 있으며 이 경우 자료가 발표된 원논문을 밝힌다. 본논문의 모 든 저자는 본논문에 실제적이고 지적인 공헌을 하였으며 논문의 내용에 대하여 공적인 책임을 공유 한다. 본논문은과거에 출판된적 이 없으며 현재 타학술지에 제출되였거나제출할계획이 없다.

제 1 저자 / 년 월 일 제 2 저자 제 3 저자

제 4 저자 제 5저자 제 6저자

〔 분 O~ :

본 동의서는 원고에 기술된 순서대로 전 저자의 서명이 있어야 함 .

대한방사선의학회 원고 최종 점검표

口 원고 1 부， 사진 1 부를 동봉한다.

디 행간 여백 1 행 (double space) 어 121 X 30cm (A4) 용지에 작성한다.

L그 원고배열은 한글과 영문으로 기재된 표지， 내표지， 초록(한글과 영문)， 서론， 대상 및 밤법， 결과， 고찰， 참고문헌， 표， 사진설명의 순으로 한다.

口 초록은 목적， 대상 및 방법， 결과 ， 걸론으로 나누어 기술한다.

口 영문초록 하단에 색인단어 (Index Words) 를 기입한다.

口 저작권에 관한 돔의서에 전 저자가 서명한다.

디 투고규정내의 저자 점검사항을 점검하였다.

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