Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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The Susceptibility Vessel Sign of the Middle Cerebral Artery on the $T2^{*}$-Weighted Gradient Echo Imaging: Semi-quantification to Predict the Response to Multimodal Intra-Arterial Thrombolysis

$T2^{*}$ 강조영상에서 보이는 중뇌동맥의 혈관자화징후: 다중방식 동맥내 혈전용해술 후 재개통 예측을 위한 반정량화

  • Youn, Sung-Won (Department of Radiology, Catholic University of Daegu Medical Center) ;
  • Jung, Cheol-Kyu (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Choi, Byung-Se (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kim, Jae-Hyoung (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kwon, O-Ki (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Han, Moon-Ku (Department of Neurology, Seoul National University Bundang Hospital) ;
  • Bae, Hee-Joon (Department of Neurology, Seoul National University Bundang Hospital) ;
  • Kwon, Bae-Ju (Department of Radiology, Kwandong University Myongji Hospital) ;
  • Han, Moon-Hee (Department of Radiology, Seoul National University Hospital)
  • 윤성원 (대구가톨릭대학교병원 영상의학과) ;
  • 정철규 (분당서울대학교병원 영상의학과) ;
  • 최병세 (분당서울대학교병원 영상의학과) ;
  • 김재형 (분당서울대학교병원 영상의학과) ;
  • 권오기 (분당서울대학교병원 신경외과) ;
  • 한문구 (분당서울대학교병원 신경과) ;
  • 배희준 (분당서울대학교병원 신경과) ;
  • 권배주 (관동대학교 명지병원 영상의학과) ;
  • 한문희 (서울대학교병원 영상의학과)
  • Published : 2011.01.01
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Abstract

Purpose: We wanted to determine whether or not the "susceptibility asymmetry index" (SAI) of acute stroke on the $T2^{*}$-weighted image is related with successful recanalization using multimodal intra-arterial thrombolysis (IAT). Materials and Methods: The 81 patients who underwent multimodal IAT for middle cerebral artery (MCA) territory acute stroke were included in this retrospective study. The multimodal IAT included intra-arterial urokinase infusion, clot disruption by a microwire, microcatheter and balloon manipulation, and balloon angioplasty and/or stenting for the flow-limiting stenosis. The diameter of the susceptibility vessel sign was measured on the $T2^{*}$-weighted gradient echo imaging (GRE), and the diameter of the contralateral normal MCA at the corresponding level was measured on magnetic resonance angiography (MRA); the ratio between these two diameters was defined as the susceptibility asymmetry index. The relation between the TICI (Thrombolysis In Cerebral Infarction) score of 2-3 after multimodal IAT and the SAI was assessed. The receiver operating characteristic (ROC) curve analysis was performed on the SAI to predict a TICI score of 2-3 after multimodal IAT. Results: The mean SAI of 81 patients was 1.66 ${\pm}$ 0.66. Seventy nine percent of the patients had a TICI of 2-3 after multimodal IAT. According to the ROC curve analysis, an SAI less than 1.3 was optimal for predicting the presence of stenotic lesion after recanalization (area under the curve: 0.821, sensitivity: 88.2%, specificity: 69.8%, p=0.0001), and the SAI ${\leq}$1.61 (area under the curve: 0.652, sensitivity: 60.9%, specificity: 70.6%, p=0.0226) could predict a TICI score of 2-3. The TICI score of 2-3 after multimodal IAT was achieved in 88.6% of the cases with a SAI ${\leq}$ 1.61 and in 67.6% of the cases with a SAI >1.61 (p=0.028). Conclusion: The lower SAI on $T2^{*}$-GRE could predict stenotic lesion and successful recanalization after performing IAT.

목적: 급성 뇌경색의 $T2^{*}$ 경사자장영상에서"자화율비대칭지수(susceptibility asymmetry index, 이하 SAI)"가 다중방식 동맥 내 혈전용해술의 재개통율과 관계가 있는지를 알아보고자 한다. 대상과 방법: 중뇌동맥 영역의 급성뇌경색에 대해서 다중방식 동맥 내 혈전용해술을 시행한 81명의 환자에 대해서 후향적 분석을 하였다. 다중방식 동맥 내 혈전용해술에는 동맥 내 유로키나아제 주입, 미세철사, 미세도관 및 풍선을 이용한 혈전분해, 혈류장애를 일으키는 협착에 대한 풍선 혈관성형술 및 스텐트 설치술을 포함한다. $T2^{*}$ 경사자장영상에서 혈관자화징후의 직경과 자기공명혈관촬영술(MRA)에서 상응하는 반대측 정상 혈관의 직경의 비를 자화율비대칭지수로 정의하였다. 동맥 내 혈전용해술과 자화율비대칭지수와의 관계를 평가하였고, 자화율비대칭지수와 TICI (Thrombolysis In Cerebral Infarction) 2-3 재개통율에 대해서 수신자판단특성 곡선(receiver operating characteristic curve) 분석을 시행하여 TICI 2-3를 예측하는데 필요한 한계치를 구하였다. 결과: 81명 환자의 자화율비대칭지수는 평균 1.66 ${\pm}$ 0.66이었다. 수신자판단특성 곡선 분석에 의하면 SAI가 1.3 미만에서 협착성 병변을 잘 예측할 수 있었고 (곡선아래면적, 0.821; 예민도, 88.2%; 특이도, 69.8%, p=0.0001). 자화율비대칭지수 1.61 이하인 경우에 높은 재개통율을 예측할 수 있고(곡선아래면적, 0.652; 예민도, 60.9%; 특이도, 70.6%; p=0.0226), 1.61 이하인 경우에 88.6%, 1.61 초과인 경우 환자의 67.6%정도에서 다중방식 동맥 내 혈전용해술로 TICI 2-3의 재개통을 시킬 수 있었다 (p=0.028). 결론: $T2^{*}$ 경사자장영상에서 자화율비대칭지수가 낮은 경우에 협착성 병변을 예측할 수 있고, 다중방식 동맥 내 혈전용해술로 좀 더 높은 재개통율을 보일 수 있다.

Keywords

References

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