Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Korean Clinical Imaging Guidelines for the Appropriate Use of Chest MRI

한국형 흉부 MRI 영상 진단 정당성 권고안

  • Jiyoung Song (Department of Radiology, Seoul National University Hospital) ;
  • Bo Da Nam (Department of Radiology, Soonchunhyang University Hospital) ;
  • Soon Ho Yoon (Department of Radiology, Seoul National University Hospital) ;
  • Jin Young Yoo (Department of Radiology, Chungbuk National University Hospital) ;
  • Yeon Joo Jeong (Department of Radiology, Pusan National University Hospital) ;
  • Chang Dong Yeo (Division of Pulmonary and Critical Care Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea) ;
  • Seong Yong Lim (Division of Pulmonary and Critical Care Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Sung Yong Lee (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital ) ;
  • Hyun Koo Kim (Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital ) ;
  • Byoung Hyuck Kim (Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Kwang Nam Jin (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Hwan Seok Yong (Department of Radiology, Korea University Guro Hospital)
  • 송지영 (서울대학교병원 영상의학과) ;
  • 남보다 (순천향대학교 서울병원 영상의학과) ;
  • 윤순호 (서울대학교병원 영상의학과) ;
  • 유진영 (충북대학교병원 영상의학과) ;
  • 정연주 (부산대학교병원 영상의학과) ;
  • 여창동 (가톨릭대학교 의과대학 은평성모병원 호흡기내과) ;
  • 임성용 (성균관대학교 의과대학 강북삼성병원 호흡기내과) ;
  • 이승룡 (고려대학교 구로병원 호흡기내과) ;
  • 김현구 (고려대학교 구로병원 흉부외과) ;
  • 김병혁 (서울특별시보라매병원 방사선종양학과) ;
  • 진광남 (서울특별시보라매병원 영상의학과) ;
  • 용환석 (고려대학교 구로병원 영상의학과)
  • Received : 2020.10.29
  • Accepted : 2021.02.01
  • Published : 2021.05.01
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Abstract

MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

MRI는 방사선 위험이 없으며, 높은 연조직 대조도 및 기능 정보 획득의 장점을 가지고 있다. 과거 기술적 한계로 흉부 분야에서 MRI의 사용이 제한되었으나, 최근 기술 발전 및 흉부 MRI의 보험 적용 확대로 흉부 MRI의 적응증과 수요가 급증할 것으로 예상된다. 이에 대한 영상의학회는 한국의 의료 실정에 맞는 흉부 MRI의 적절한 활용과 관련된 지침의 개발이 필요하다고 보고 개발위원회, 실무위원회 및 자문위원회의 의견을 모아 한국형 흉부 MRI 정당성 가이드라인을 개발하였다. 5가지 문장형 핵심질문을 선정하고, 근거기반 임상영상 가이드라인 수용개작 방법론에 의거하여 권고안을 작성하였다. 권고 내용은 다음과 같다. 우연히 발견된 전종격동 병변 환자에서 비종양성 질환 진단을 위하여 흉부 MRI를 권장한다. 폐 종괴가 발견된 진폐증 환자에서 악성 종양과 진행성거대섬유증의 감별 진단을 위하여 흉부 MRI를 권장한다. 악성 흉막 중피종 또는 비소세포 폐암 환자에서 흉벽, 척추, 횡격막 또는 혈관 침범이 의심되는 경우 흉부 MRI를 권장한다. 임산부에서 임상적으로 폐색전증이 의심되나, 다른 검사가 불충분할 경우 비조영 흉부 MRI 혹은 중등도 또는 저위험군 조영제를 가능한 최소한의 용량으로 사용하여 조영증강 흉부 MRI를 고려할 수 있다. 폐첨부 폐암 환자에서 근치적 절제술을 고려할 경우 혈관 및 경막 외 공간의 종양 침범을 확인하기 위해 흉부 MRI를 권고한다.

Keywords

Acknowledgement

We thank Chang-Hee Cho for her contributions to data acquisition and support.

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