Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Myocardial Viability: Comparison of Free-Breathing Navigator-echo-gated Three-Dimensional Inversion-Recovery Gradient-Echo MR and Standard Multiple Breath-Hold Two-Dimensional Inversion-Recovery Gradient-Echo MR

심근 생존능: 횡격막 운동 동기화 자유호흡 3차원 역전회복 경사에코 자기공명영상과 호흡정지 2차원 역전회복 경사에코 자기공명영상의 비교

Kim, Jin-Hee;Seo, Joon-Beom;Do, Kyung-Hyun;Yang, Dong-Hyun;Lee, Soo-Hyun;Ko, Sung-Min;Heo, Jeong-Nam;Lim, Tae-Hwan
김진희;서준범;도경현;양동현;이수현;고성민;허정남;임태환

  • Published : 20040000
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Abstract

Purpose: To compare a free-breathing, navigator-echo-gated, three-dimensional, inversion-recovery, gradientecho, MR pulse sequence (3D-MRI) with standard, multiple breath-hold, two-dimensional, inversion-recovery, gradient-echo MR (2D-MRI) for the evaluation of delayed hyperenhancement of nonviable myocardium in patients with chronic ischemic heart disease. Materials and Methods: Ten patients with chronic ischemic heart disease were enrolled in this study. MRI was performed on a 1.5-T system. 3D-MRI was obtained in the short axis plane at 10 minutes after the administration of Gd-DTPA (0.2 mmol/kg, 4 cc/sec). Prospective gating of the acquisition based on the navigator echo was applied. 2D-MRI was performed immediately after finishing 3D-MRI. The area of total and hyperenhanced myocardium measured on both image sets was compared with paired Student t-test and Bland-Altman method. By using a 60-segment model, the transmural extent and segmental width of the hyperenhanced area were recorded by 3-scale grading method. The agreement between the two sequences was evaluated with kappa statistics. We also evaluated the agreement of hyperenhancement among the three portions (apical, middle and basal portion) of the left ventricle with kappa statistics. Results: The two sequences showed good agreement for the measured area of total and hyperenhanced myocardium on paired t-test (p=0.11 and p=0.34, respectively). No systematic bias was shown on Bland-Altman analysis. Good agreement was found for the segmental width (ĸ=0.674) and transmural extent (ĸ=0.615) of hyperenhancement on the segmented analysis. However, the agreement of the transmural extent of hyperenhancement in the apical segments was relatively poor compared with that in the middle or basal portions. Conclusion: This study showed good agreement between 3D-MRI and 2D-MRI in evaluation of non-viable myocardium. Therefore, 3D-MRI may be useful in the assessment of myocardial viability in patients with dyspnea and children because it allows free-breathing during the examination.

목적: 만성 허혈성 심질환 환자에서 괴사 심근의 지연조영증강을 평가함에 있어서 횡격막 운동 동기화 자유 호흡 3차원 역전회복 경사에코 자기공명영상(3D-MRI)과 호흡정지 2차원 역전 회복 경사에코 자기공명영상(2D-MRI)을 비교하여 3D-MRI의 유용성을 알아보고자 하였다. 대상과 방법: 10명의 만성 허혈성 심질환 환자를 대상으로 1.5-T 장비로 MRI를 시행하였다. 3D-MRI는 Gd-DTPA(0.2 mmol/kg, 4 cc/sec) 투여 10분 후에 단축면 영상으로 얻었으며 횡격막 운동 동기화 기법을 이용하여 전향적 호흡동기를 적용하였다. 2D-MRI는 3D-MRI 직후에 시행하였다. 각 기법에서 전체 심근과 지연조영증강을 보이는 심근, 즉 괴사 심근의 면적을 구하여 paired Student t-test와 Bland-Altman 방법을 이용하여 비교하였다. 60분절 모델을 이용하여 지연조영증강 영역의 통벽성 정도 및 분절폭을 각각 세 단계로 나누어 두 기법 간의 일치도를 kappa 통계 기법으로 비교하였다. 또한 전체 심근 영역을 첨부, 중간부, 기저부로 나누어 지연조영증강 영역이 각 부위에서 어떠한 차이를 보이는지 알아보았다. 결과: 두 기법 간에 전체 심근(p=0.11)과 괴사 심근(p=0.34)의 면적은 차이가 없었으며 Bland-Altman 분석에서 계통적 치우침도 보이지 않았다. 60분절 모델 분석에서 통벽성 정도(ĸ=0.674)와 분절폭(ĸ=0.615)은 잘 일치하였으나 심첨부에서 통벽성 정도의 일치도가 낮은 경향을 보였다. 결론: 만성 허혈성 심질환 환자에서 괴사 심근의 지연조영증강을 평가함에 있어서 3D-MRI는 2D-MRI와 높은 일치도를 보여 심근 생존능의 빠르고 정확한 평가가 가능하였다. 따라서 3DMRI는 호흡 곤란이 심한 환자나 소아 환자의 심근 생존능을 평가하는 데 유용할 것이다.

Keywords

References

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