• Korean Journal of Radiology
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• 제22권12호
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• pp.1946-1963
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• 2021

Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) can reveal the detailed anatomy and function of the tricuspid valve and right ventricle (RV). Quantification of tricuspid regurgitation (TR) and analysis of RV function have prognostic implications. With the recently available transcatheter treatment options for diseases of the tricuspid valve, evaluation of the tricuspid valve using CT and CMR has become important in terms of patient selection and procedural guidance. Moreover, CT enables post-procedural investigation of the causes of valve dysfunction, such as pannus or thrombus. This review describes the anatomy of the tricuspid valve and CT and CMR imaging protocols for right heart evaluation, including RV function and TR analyses. We also demonstrate the pre-procedural planning for transcatheter treatment of TR and imaging of postoperative complications using CT.

• 대한핵의학회지
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• 제38권5호
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• pp.331-337
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• 2004

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MIBG is most available and relatively well-established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with I-123 MIBG imaging nay be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy.

• Investigative Magnetic Resonance Imaging
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• 제25권4호
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• pp.252-265
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• 2021

Cardiac magnetic resonance imaging (MRI) serves as a clinical gold-standard non-invasive imaging technique for the assessment of global and regional cardiac function. Conventional cardiac MRI is limited by the long acquisition time, the need for ECG gating and/or long breathhold, and insufficient spatiotemporal resolution. Real-time cardiac cine MRI refers to high spatiotemporal cardiac imaging using data acquired continuously without synchronization or binning, and therefore of potential interest in overcoming the limitations of conventional cardiac MRI. Novel acquisition and reconstruction techniques must be employed to facilitate real-time cardiac MRI. The goal of this study is to discuss methods that have been developed for real-time cardiac MRI. In particular, we classified existing techniques into two categories based on the use of non-iterative and iterative reconstruction. In addition, we present several research trends in this direction, including deep learning-based image reconstruction and other advanced real-time cardiac MRI strategies that reconstruct images acquired from real-time free-breathing techniques.

• Korean Journal of Radiology
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• 제22권9호
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• pp.1441-1450
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• 2021

Anomalous origin of the coronary artery from the pulmonary artery is a rare and potentially fatal congenital heart defect. Up to 90% of infants with an anomaly involving the left coronary artery die within the first year of life if left untreated. Patients who survive beyond infancy are at risk of sudden cardiac death. Cardiac CT and MRI are increasingly being used for the accurate diagnosis of this anomaly for prompt surgical restoration of the dual coronary artery system. Moreover, life-long imaging surveillance after surgery is necessary for these patients. In this pictorial review, multimodal cardiac imaging findings of this rare and potentially fatal coronary artery anomaly are comprehensively discussed, and representative images are provided to facilitate the understanding of this anomaly.

• Nuclear Medicine and Molecular Imaging
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• 제43권3호
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• pp.174-178
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• 2009

Many radiopharmaceuticals have been developed and wildy used in the imaging cardiac function. Myocardial perfusion imaging (MPI) is a well established noninvasive method of assessing coronary blood flow and has been widely used in patients diagnosed or suspected with coronary artery diseases. The innovation of radiopharmaceuticals used in the cardiac imaging is one of the most important contributors to the development of nuclear cardiology. Thallium-201 and various technetium-99m agents have been globally used for myocardial perfusion SPEG, and N-13 ammonia (13NH3), rubidium-82 (82Rb), 0-15 water (H2150) for myocardial perfusion PET. As well as the cardiac perfusion studies, new radiopharmaceuticals that visualize fat metabolism or receptors of the sympathetic nervous system have successfully been applied to clinical practice. Useful information can be obtained for diagnosing coronary artery disease, evaluating patients' condition, or assessing therapeutic effects. In this review, we describe the characteristics and clinical usefulness of radiopharmaceuticals used for cardiac SPEG and PET.

• Investigative Magnetic Resonance Imaging
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• 제11권1호
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• pp.1-9
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• 2007

심장의 영상화에 장애가 되는 요인은 심장 운동, 호흡, 심장 내 혈류 등에 의한 인공물(artifact) 과 심장 조직의 용적이 작음으로 인한 낮은 신호 대 잡음비 등이 있다. 심장 운동에 의한 화질 저하를 막기 위해 신속영상기법(fast imaging technique) 을 이용하여 심장 운동의 특정 위상(phase) 에서만 영상을 얻는 심장동기(cardiac gating) 방법을 이용하고 있다. MRI를 이용한 심장의 검사는 심장의 형태, 심실 기능, 심근 관류, 심근 대사, 관상동맥 영상 등을 대상으로 한다. 심장의 형태적 진단에 있어서 심근내 수분의 정도와 지방조직을 보기 위해 이중(double) 혹은 삼중역전회복기법(triple inversion recovery technique) 을 사용한다. 심근관류검사를 위해서는 조영증강신속경사에코법(contrast-enhanced fast gradient echo technique)을 사용하여 일차통과조영증강(first-pass enhancement) 을 검사한다. 또한 10-15분 지연영상을 얻어 심근내 조영제의 재분포를 검사하여 만성심근경색 등의 심근파괴부위를 확인한다. 심실기능 평가를 위해서는 신속경사에 코법을 이용한 영화영상(cine image) 이 사용되며 심실의 국소적 운동이상 및 심실기능의 정량적 검사가 가능하다. MRI는 관상동맥영상을 제외한 포괄적 심장검사에 실용성이 있다. 특히 지연영상은 다른 검사장비에선 얻을수 없는 유용한 정보이다.

• Investigative Magnetic Resonance Imaging
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• 제23권2호
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• pp.100-113
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• 2019

Sarcoidosis is a multisystem disease characterized by noncaseating granulomas. Cardiac involvement is known to have poor prognosis because it can manifest as a serious condition such as the conduction abnormality, heart failure, ventricular arrhythmia, or sudden cardiac death. Although early diagnosis and early treatment is critical to improve patient prognosis, the diagnosis of CS is challenging in most cases. Diagnosis usually relies on endomyocardial biopsy (EMB), but its diagnostic yield is low due to the incidence of patchy myocardial involvement. Guidelines for the diagnosis of CS recommend a combination of clinical, electrocardiographic, and imaging findings from various modalities, if EMB cannot confirm the diagnosis. Especially, the role of advanced imaging such as cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET), has shown to be important not only for the diagnosis, but also for monitoring treatment response and prognostication. CMR can evaluate cardiac function and fibrotic scar with good specificity. Late gadolinium enhancement (LGE) in CMR shows a distinctive enhancement pattern for each disease, which may be useful for differential diagnosis of CS from other similar diseases. Effectively, T1 or T2 mapping techniques can be also used for early recognition of CS. In the meantime, PET can detect and quantify metabolic activity and can be used to monitor treatment response. Recently, the use of a hybrid CMR-PET has introduced to allow identify patients with active CS with excellent co-localization and better diagnostic accuracy than CMR or PET alone. However, CS may show various findings with a wide spectrum, therefore, radiologists should consider the possible differential diagnosis of CS including myocarditis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Radiologists should recognize the differences in various diseases that show the characteristics of mimicking CS, and try to get an accurate diagnosis of CS.

• 대한의용생체공학회:의공학회지
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• 제33권1호
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• pp.39-46
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• 2012

Electrical impedance tomography(EIT) can produce functional images with conductivity distributions associated with physiological events such as cardiac and respiratory cycles. EIT has been proposed as a clinical imaging tool for the detection of stroke and breast cancer, pulmonary function monitoring, cardiac imaging and other clinical applications. However EIT still suffers from technical challenges such as the electrode interface, hardware limitations, lack of animal or human trials, and interpretation of conductivity variations in reconstructed images. We improved the KHU Mark2 EIT system by introducing an EIT electrode interface consisting of nano-web fabric electrodes and by adding a synchronized biosignal measurement system for gated conductivity imaging. ECG and respiration signals are collected to analyze the relationship between the changes in conductivity images and cardiac activity or respiration. The biosignal measurement system provides a trigger to the EIT system to commence imaging and the EIT system produces an output trigger. This EIT acquisition time trigger signal will also allow us to operate the EIT system synchronously with other clinical devices. This type of biosignal gated conductivity imaging enables capture of fast cardiac events and may also improve images and the signal-to-noise ratio (SNR) by using signal averaging methods at the same point in cardiac or respiration cycles. As an example we monitored the beat by beat cardiac-related change of conductivity in the EIT images obtained at a common state over multiple respiration cycles. We showed that the gated conductivity imaging method reveals cardiac perfusion changes in the heart region of the EIT images on a canine animal model. These changes appear to have the expected timing relationship to the ECG and ventilator settings that were used to control respiration. As EIT is radiation free and displays high timing resolution its ability to reveal perfusion changes may be of use in intensive care units for continuous monitoring of cardiopulmonary function.

• Investigative Magnetic Resonance Imaging
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• 제22권1호
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• pp.56-60
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• 2018

Therapeutic hypothermia in cardiac arrest patients is associated with favorable outcomes mediated via neuroprotective mechanisms. We report a rare case of a 32-year-old male who demonstrated complete recovery of signal changes on perfusion-weighted imaging after therapeutic hypothermia due to cardiac arrest. Brain MRI with perfusion-weighted imaging, performed three days after ending the hypothermia therapy, showed a marked decrease in relative cerebral blood flow (rCBF) and delay in mean transit time (MTT) in the bilateral basal ganglia, thalami, brain stem, cerebellum, occipitoparietal cortex, and frontotemporal cortex. However, no cerebral ischemia was not noted on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) sequences. A follow-up brain MRI after one week showed complete resolution of the perfusion deficit and the patient was discharged without any neurologic sequelae. The mechanism and interpretation of the perfusion changes in cardiac arrest patients treated with therapeutic hypothermia are discussed.

• 대한영상의학회지
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• 제85권2호
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• pp.308-326
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• 2024

심장 기능의 포괄적인 결과는 심장박출량과 전신 정맥 환류로 표현된다. 심장의 4개의 방실은 각자 고유한 기계적 기능을 가진다. 심장방실과 판막, 폐순환 시스템은 전부하 또는 후부하의 형태로 상호 연관되어 있다. 심장 기능 장애는 전반적인 심장 기능의 실패로 전형적인 임상 증상을 나타낸다. 심장 기능 장애의 근본 원인을 조사하려면 심장 내 혈류 유동 경로에 대한 단계별 평가가 필요하다. 이러한 맥락에서, 심장의 세부 구조를 볼 수 있는 영상검사의 표지자는 심장 기능 평가에 중요한 역할을 한다. 영상기반 평가를 통해 개별 심장 구성 요소의 기능을 단계별로 조사할 수 있다. 심장 기능 평가를 위한 영상검사 중 최근 심장 CT가 포함되고 검증되었다. 본 종설에서는 포괄적 및 단계별 심장 기능 평가를 위한 심장 CT 기반 영상 표지자에 대해 논의하겠다.