Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Cerebrovascular Reservoir and Arterial Transit Time Changes Assessed by Acetazolamide-Challenged Multi-Phase Arterial Spin Labeling Perfusion MRI in Chronic Cerebrovascular Steno-Occlusive Disease

만성 뇌혈관 협착폐색증에서 아세타졸아미드 부하 다상 동맥스핀표지 자기공명관류영상으로 평가한 뇌혈류 예비능과 동맥 통과 시간의 변화

  • Inpyeong Hwang (Department of Radiology, Seoul National University Hospital) ;
  • Chul-Ho Sohn (Department of Radiology, Seoul National University Hospital) ;
  • Keun-Hwa Jung (Department of Neurology, Seoul National University Hospital) ;
  • Eung Koo Yeon (Department of Radiology, Seoul National University Hospital) ;
  • Ji Ye Lee (Department of Radiology, Seoul National University Hospital) ;
  • Roh-Eul Yoo (Department of Radiology, Seoul National University Hospital) ;
  • Koung Mi Kang (Department of Radiology, Seoul National University Hospital) ;
  • Tae Jin Yun (Department of Radiology, Seoul National University Hospital) ;
  • Seung Hong Choi (Department of Radiology, Seoul National University Hospital) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University Hospital)
  • 황인평 (서울대학교병원 영상의학과) ;
  • 손철호 (서울대학교병원 영상의학과) ;
  • 정근화 (서울대학교병원 신경과) ;
  • 연응구 (서울대학교병원 영상의학과) ;
  • 이지예 (서울대학교병원 영상의학과) ;
  • 유노을 (서울대학교병원 영상의학과) ;
  • 강경미 (서울대학교병원 영상의학과) ;
  • 윤태진 (서울대학교병원 영상의학과) ;
  • 최승홍 (서울대학교병원 영상의학과) ;
  • 김지훈 (서울대학교병원 영상의학과)
  • Received : 2020.12.08
  • Accepted : 2020.12.31
  • Published : 2021.05.01
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Abstract

Purpose To explore cerebrovascular reservoir (CVR) and arterial transit time (ATT) changes using acetazolamide-challenged multi-phase arterial spin labeling (MP-ASL) perfusion-weighted MRI in chronic cerebrovascular steno-occlusive disease. Materials and Methods This retrospective study enrolled patients with chronic steno-occlusion who underwent acetazolamide-challenged MP-ASL between June 2019 and October 2020. Cerebral blood flow, CVR, basal ATT, and ATT changes associated with severe stenosis, total occlusion, and chronic infarction lesions were compared. Results There were 32 patients (5 with bilateral steno-occlusion) in our study sample. The CVR was significantly reduced during total occlusion compared with severe stenosis (26.2% ± 28.8% vs. 41.4% ± 34.1%, respectively, p = 0.004). The ATT changes were not significantly different (p = 0.717). The CVR was marginally lower in patients with chronic infarction (29.6% ± 39.1% vs. 38.9% ± 28.7%, respectively, p = 0.076). However, the ATT was less shortened in patients with chronic infarction (-54 ± 135 vs. -117 ± 128 ms, respectively, p = 0.013). Conclusion Acetazolamide-challenged MP-ASL provides an MRI-based CVR evaluation tool for chronic steno-occlusive disease.

목적 만성 뇌동맥 협착-폐색증에서 아세타졸아미드 부하 다상 동맥 스핀 표지(multi-phase arterial spin labeling; 이하 MP-ASL) 자기공명관류영상을 이용하여 뇌혈류 예비능(cerebrovascular reservoir; 이하 CVR)과 동맥 통과 시간(arterial transit time; 이하 ATT)의 변화를 탐색하였다. 대상과 방법 2019년 6월부터 2020년 10월까지 새롭게 만성 협착-폐색증으로 진단되어 아세타졸아미드 부하 MP-ASL을 시행한 환자를 후향적으로 모집하였다. 부하 전후의 뇌혈류(cerebral blood flow), CVR, 부하전 ATT 및 부하 전후의 ATT 변화량을 중증 협착과 완전 폐색간, 만성 뇌경색 병변의 유무에 따라 비교하였다. 결과 5명의 양측성 협착-폐색을 포함하여 총 32명의 환자가 본 연구에 포함되었다. CVR은 완전 폐색에서 중증 협착보다 유의하게 낮았다(26.2% ± 28.8% vs. 41.4% ± 34.1%, p = 0.004). ATT의 변화는 두 군간 유의한 차이는 없었다(p = 0.717). 만성 뇌경색 병변의 유무에 따른 CVR의 통계적 차이는 미미하였다(29.6% ± 39.1% vs. 38.9% ± 28.7%, p = 0.076). 하지만, 만성 뇌경색 병변이 있는 환자에서 ATT의 단축 정도는 유의하게 작았다(-54 ± 135 vs. -117 ± 128 ms, p = 0.013). 결론 만성 협착-폐색증에서 아세타졸아미드 부하 MP-ASL 검사는 MRI 기반의 CVR 평가 도구로 사용될 수 있다.

Keywords

Acknowledgement

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. 2018M3C7A1056884 and 2018M3C7A1056888).

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