Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Comparison of MRI Sequences for the Detection of Cerebral Venous Sinus Thrombosis During Follow-Up Examination

뇌정맥동혈전의 추적 검사에서 MRI Sequence의 진단적 가치 비교

  • Choi, Ji Eun (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Weon, Young Cheol (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Gyeong Min (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kwon, Jee-Hyun (Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Wook-Joo (Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kwon, Woon-Jung (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Seong Hoon (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 최지은 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 원영철 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 박경민 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 권지현 (울산대학교 의과대학 울산대학교병원 신경과) ;
  • 김욱주 (울산대학교 의과대학 울산대학교병원 신경과) ;
  • 권운정 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 최성훈 (울산대학교 의과대학 울산대학교병원 영상의학과)
  • Received : 2017.11.18
  • Accepted : 2018.02.06
  • Published : 2018.05.01
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Abstract

Purpose: To compare the diagnostic performance of magnetic resonance (MR) sequences for the evaluation of cerebral venous sinus thrombosis (CVST) during followup examinations. Materials and Methods: Thirteen cases that were confirmed to be CVST between January 2006 and March 2016 were included in this study. Two neuroradiologists independently examined each initial and follow-up MR sequence image in random order. Results: Gadolinium-enhanced T1-weighted imaging (Gd-enhanced T1WI) was the most sensitive sequence for the detection of CVST in the initial and follow-up MR examinations (82% and 55.3%, respectively). Among the non-enhanced MR sequences of the initial examination, gradient-recalled echo was the most sensitive (77.4%), fluid-attenuated inversion recovery (FLAIR) had low sensitivity (34.4%). The overall diagnostic performances of all MR sequences except for FLAIR decreased during the follow-up. FLAIR was the most sensitive during follow-up, and was also the only sequence with increased sensitivity during follow-up (from 34.4% to 55.6%). Conclusion: Gd-enhanced T1WI had the best diagnostic performance for CVST in both initial and follow-up MR examinations. Therefore, it is reasonable to use Gd-enhanced T1WI to evaluate CVST during follow-up examinations. However, for patients who cannot tolerate MR contrast agents, the use of FLAIR to assess the remaining CVST during the follow-up may be helpful.

목적: 뇌정맥동혈전을 진단받은 환자의 추적 검사에서 각각의 magnetic resonance imaging (이하 MRI) sequence의 진단적 가치를 비교하였다. 대상과 방법: 2006년 1월에서 2016년 3월까지 본원에서 MRI를 통해 뇌정맥동혈전을 진단받은 환자 중 추적 검사를 시행한 총 13명의 환자가 최종적으로 연구에 포함되었다. 두 명의 신경영상의학과 의사가 각각의 MR sequence image에서 모든 뇌정맥동 구역에 대해 뇌정맥동혈전의 유무를 평가하였다. 이를 바탕으로 추적 검사에서 각 sequence의 뇌정맥동혈전에 대한 진단적 가치를 비교하였다. 결과: 최초 및 추적 MRI 검사에서 가장 민감도가 높은 sequence는 조영증강 T1-weighted imaging (이하 T1WI)였다(각각 82%와 55.3%). 최초 MRI 검사에서 비조영 sequence 중에서 가장 민감도가 높은 것은 gradient-recalled echo(77.4%)였고 반면 fluid-attenuated inversion recovery (이하 FLAIR)는 낮은 민감도를 보였다(34.4%). 추적 검사에서 FLAIR를 제외한 모든 sequence의 진단적 가치는 감소하였다. 추적 검사에서 FLAIR는 가장 민감도가 높았고 유일하게 34.4%에서 55.6%로 민감도가 상승한 sequence였다. 결론: 조영증강 T1WI는 최초 및 추적 MRI 검사에서 뇌정맥동혈전에 가장 높은 진단적 가치를 보였다. 그러므로 뇌정맥동혈전의 추적 검사에 있어 조영증강 sequence는 합당하다고 할 수 있다. 그러나 MRI 조영제를 사용할 수 없는 환자의 경우에, 치료 효과 판정에 있어 FLAIR image에서 혈전의 신호 변화를 이해하는 것이 진단에 도움이 될 수 있을 것이다.

Keywords

Acknowledgement

Supported by : Bracco image Korea

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