Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지

Contrast-Enhanced Magnetic Resonance Angiography for Evaluation of the Steno-occlusive Disease of the Supraaortic Arteries: Comparison with Computed Tomography Angiography and Digital Subtraction Angiography

조영증강 자기공명 혈관조영술을 이용한 대동맥궁 위 혈관의 협착 및 페쇄 질환 평가: 전산화 단층 혈관조영술 및 디지털 감산혈관조영술과의 비교

  • Jeh, Su-Kyung (Department of Radiology, St.Mary Hospital, The Catholic University of Korea) ;
  • Kim, Bum-Soo (Department of Radiology, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Jung, So-Lyung (Department of Radiology, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Ahn, Kook-Jin (Department of Radiology, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Shin, Yong-Sam (Department of Neurosurgery, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Lee, Kwan-Sung (Department of Neurosurgery, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Kim, Young-In (Department of Neurology, Seoul St.Mary Hospital, The Catholic University of Korea) ;
  • Lee, Kwang-Soo (Department of Neurology, Seoul St.Mary Hospital, The Catholic University of Korea)
  • 제수경 (가톨릭대학교 의과대학 방사선과학교실, 성모병원 영상의학과) ;
  • 김범수 (가톨릭대학교 의과대학 방사선과학교실, 서울성모병원 영상의학과) ;
  • 정소령 (가톨릭대학교 의과대학 방사선과학교실, 서울성모병원 영상의학과) ;
  • 안국진 (가톨릭대학교 의과대학 방사선과학교실, 서울성모병원 영상의학과) ;
  • 신용삼 (가톨릭대학교 의과대학 신경외과학교실, 서울성모병원 신경외과) ;
  • 이관성 (가톨릭대학교 의과대학 신경외과학교실, 서울성모병원 신경외과) ;
  • 김영인 (가톨릭대학교 의과대학 신경과학교실, 서울성모병원 신경과) ;
  • 이광수 (가톨릭대학교 의과대학 신경과학교실, 서울성모병원 신경과)
  • Published : 2009.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : To intra-individually compare diagnostic accuracy of high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) with computed tomography angiography (CTA) and digital subtraction angiography (DSA) for the assessment of supraaortic steno-occlusive disease. Materials and Methods : Twenty-eight patients (20 men, 8 women, 53-79 years of age) underwent supraaortic CE-MRA, CTA and DSA. CE-MRA was performed on two 1.5T MR scanners (voxel dimension: $0.66{\times}0.66{\times}1.1$ or $1.2\;mm^3$), and CTA on 64-slice CT scanners (voxel dimension: $0.42{\times}0.42{\times}0.63\;mm^3$). All the three examinations were completed within 40 days (median 19 days; range 1-40 days). Retrospective evaluation and measurement of diameter of 6 extracranial and 9 intracranial arterial segments was done by 2 experienced radiologists. Results: A total of 420 arterial segments were examined by CE-MRA, CTA and DSA. On DSA, 34 stenoocclusive lesions were noted at extracranial (n= 19) and intracranial (n = 15) vessels. For extracranial stenosis greater than 70%, sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 94.7%, 98.7%, 90.0% and 99.3% on CE-MRA, and 94.7%, 99.3%, 94.7% and 99.3% on CTA. For intracranial stenosis greater than 50%, sensitivity; specificity, PPV and NPV were 93.3%, 98.3%, 77.8%and 99.6% on CE-MRA, and 86.7%, 97.9%, 72.2% and 99.1 % on CTA, with DSA as the standard of reference. Conclusion : Supraaortic CE-MRA is as reliable as CTA in depicting the arterial stenosis, and is effective in screening of significant stenosis of both extracranial and intracranial arterial stenosis.

목적: 대동맥궁 상부의 두개강내외 동맥의 협착을 평가함에 있어 3차원 조영증강 자기공명영상 혈관조영술(contrast-enhanced magnetic resonance angiography, CE-MRA), 전산화 단층 혈관 조영술(computed tomographic angiography, CTA),그리고 디지털 감산 혈관조영술(digital subtraction angiography)의 진단 정확도를 비교하고자 하였다. 대상 및 방법: 총 대동맥궁 상부의 두개강내외 동맥에 대해 CE-MRA (화소크기: $0.66{\times}0.66{\times}1.1$ 혹은 $1.2\;mm^3$), CTA (화소크기: $0.42{\times}0.42{\times}0.63\;mm^3$), 그리고 DSA를 모두 시행한 28명의 환자(남자20명, 여자 8명, 나이: 53-79세)를 대상으로 하였다. 세 영상검사는 40일 이내에 모두 시행되었다 (중앙값 19일, 1-40일). 두명의 경험 있는 영상의학 전문의가 영상에 대한 평가 및 미리 설정된 15개 구간의 동맥 직경의 측정을 후향적으로 시행하였다. 결과: 총 420 구간의 동맥에 대한 평가가 CE-MRA, CTA및 DSA에서 가능하였다. DSA에서 34부위의 협착 혹은 폐색 병변이 관찰되었으며, 이중 19예는 두 개강외에 15예는 두개강내에 위치하였다. DSA를 기준으로 평가하였을 때, 두개강외 혈관에서 70%이상의 혈관협착을 진단하는데 있어 CE-MRA는 민감도 94.7%, 특이도 98.7%, 양성 예측도(PPV) 90.0%, 음성예측도(NPV) 99.3% 였고, CTA는 각각 94.7%, 99.3%, 94.7%, 99.3% 였다. 두개강내 혈관의 50% 이상 혈관 협착을 진단하는데에는 CE-MRA의 민감도가 93.3%, 특이도 98.3%, 양성예측도(PPV) 77.8%, 음성예측도(NPV) 99.6%였고, CTA에서는 각각 86.7%, 97.9%, 72.2%, 99.1%였다. 결론: 대동맥궁 상부의 두개강외와 두개강내의 동맥 협착을 진단함에 있어 CE-MRA는 CTA와 비슷한 정도의 신뢰성을 보이며, 두개강내외의 의미있는 동맥 협착에 대한 선별검사로 효과적이다.

Keywords

References

  1. Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990;21:209-222 https://doi.org/10.1161/01.STR.21.2.209
  2. Heiserman JE, Dean BL, Hodak JA, Flom RA, Bird CR, Drayer BP, et al.Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 1994;15:1401-1407; discussion 1408-1411
  3. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: Prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522-528 https://doi.org/10.1148/radiol.2272012071
  4. Agid R, Willinsky RA, Lee SK, Terbrugge KG, Farb RI. Characterization of aneurysm remnants after endovascular treatment: Contrast-enhanced MR angiography versus catheter digital subtraction angiography. AJNR Am J NeuroradioI 2008;29:1570-1574 https://doi.org/10.3174/ajnr.A1124
  5. Teksam M, McKinney A, Casey S, Asis M, Kieffer S, Truwit CL. Multi-section ct angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol 2004;25: 1485-1492
  6. Berg M, Zhang Z, Ikonen A, Sipola P, Kalviainen R, Manninen H et al. Multi-detector row ct angiography in the assessment of carotid artery disease in symptomatic patients: Comparison with rotational angiography and digital subtraction angiography. AJNR Am J Neuroradiol 2005;26:1022-1034
  7. Josephson SA, Bryant SO, Mak HK, Johnston SC, Dillon WP, Smith WS.Evaluation of carotid stenosis using ct angiography in the initial evaluation of stroke and TIA. Neurology 2004;63:457-460 https://doi.org/10.1212/01.WNL.0000135154.53953.2C
  8. Oelerich M, Lentschig MG, Zunker P, Reimer P, Rummeny EJ, Schuierer G. Intracranial vascular stenosis and occlusion: Comparison of 3d time-of-flight and 3d phase-contrast MR angiography. Neuroradiology 1998;40:567-573 https://doi.org/10.1007/s002340050645
  9. Remonda L, Senn P, Barth A, Arnold M, Lovblad KO, Schroth G. Contrast-enhanced 3d mr angiography of the carotid artery: Comparison with conventional digital subtraction angiography. AJNR Am J NeuroradioI 2002;23:213-219
  10. Skutta B, Furst G, Eilers J, Ferbert A, Kuhn FP. Intracranial stenoocclusive disease: Double-detector helical ct angiography versus digital subtraction angiography. AJNR Am J NeuroradioI 1999;20:791-799
  11. Villablanca JP, Nael K, Habibi R, Nael A, Laub G, Finn JP. 3 T contrast-enhanced magnetic resonance angiography for evaluation of the intracranial arteries: Comparison with timeof-flight magnetic resonance angiography and multislice computed tomography angiography. Invest Radiol 2006;41:799-805 https://doi.org/10.1097/01.rli.0000242835.00032.f5
  12. Chappell FM, Wardlaw JM, Young GR, Gillard JH, Roditi GH, Yip B, et al. Carotid artery stenosis: Accuracy of noninvasive tests-individual patient data meta-analysis. Radiology 2009;251:493-502 https://doi.org/10.1148/radiol.2512080284
  13. Muhlenbruch G, Das M, Mommertz G, Schaaf M, Langer S, Mahnken AH, et al. Comparison of dual-source CT angiography and MR angiography in preoperative evaluation of intra- and extra cranial vessels: a pilot study. Eur Radiol 2009;DOI 10.1007/s00330-009-1547-7
  14. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J NeuroradioI 2000;21:643-646
  15. North american symptomatic carotid endarterectomy trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-453 https://doi.org/10.1056/NEJM199108153250701
  16. European carotid surgery trialists' collaborative group. MRCeuropean carotid surgery trial: Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991;337:1235-1243 https://doi.org/10.1016/0140-6736(91)92916-P
  17. Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. Guidelines for carotid endarterectomy: a statement for health care professionals from a special writing group of the stroke council, american heart association. Circulation 1998; 97:501-509 https://doi.org/10.1161/01.CIR.97.5.501
  18. Chimowitz MI, Lynn MJ, Hewlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR et al.Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352:1305-1316 https://doi.org/10.1056/NEJMoa043033
  19. Babiarz LS, Astor B, Mohamed MA, Wasserman BA.Comparison of gadolinium-enhanced cardiovascular magnetic resonance angiography with high-resolution black blood cardiovascular magnetic resonance for assessing carotid artery stenosis. J Cardiovasc Magn Reson 2007; 963-70
  20. Cosottini M, Pingitore A, Puglioli M, Michelassi MC, Lupi G, Abbruzzese A et al. Contrast-enhanced three-dimensional magnetic resonance angiography of atherosclerotic internal carotid stenosis as the noninvasive imaging modality in revascularization decision making. Stroke 2003;34:660-664 https://doi.org/10.1161/01.STR.0000057462.02141.6F
  21. Randoux B, Marro B, Koskas F, Duyme M, Sahel M, Zouaoui A et al. Carotid artery stenosis: Prospective comparison of ct. three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology 2001;220:179-185 https://doi.org/10.1148/radiology.220.1.r01jl35179
  22. Leclerc X, Nicol L, Gauvrit JY, Le Thuc V, Leys D, Pruvo JP. Contrast-enhanced MR angiography of supraaortic vessels: The effect of voxel size on image quality. AJNR Am J NeuroradioI 2000;21:1021-1027
  23. Babiarz LS, Romero JM, Murphy EK, Brobeck B, Schaefer PW, Gonzalez RG et al. Contrast-enhanced mr angiography is not more accurate than un enhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis. AJNR Am J Neuroradiol 2009;30:761-768 https://doi.org/10.3174/ajnr.A1464
  24. Riederer SJ, Fain SB, Kruger DG, Busse RF. 3D contrast-enhanced MR angiography using fluoroscopic triggering and an elliptical centric view order. Int J Card Imaging 1999; 15:117-129 https://doi.org/10.1023/A:1006122514980
  25. Wilman AH, Riederer SJ, Huston J, 3rd, Wald JT, Debbins JP. Arterial phase carotid and vertebral artery imaging in 3D contrast-enhanced MR angiography by combining fluoroscopic triggering with an elliptical centric acquisition order. Magn Reson Med 1998;40:24-35 https://doi.org/10.1002/mrm.1910400104
  26. Willinek WA, Gieseke J, Conrad R, Strunk H, Hoogeveen R, von Falkenhausen M, et al. Randomly segmented central kspace ordering in high-spatial-resolution contrast-enhanced mr angiography of the supraaortic arteries: Initial experience. Radiology 2002;225:583-588 https://doi.org/10.1148/radiol.2252011167
  27. Willinek WA, von Falkenhausen M, Born M, Gieseke J, Holler T, Klockgether T, et al. Noninvasive detection of steno-occlusive disease of the supra-aortic arteries with three-dimensional contrast-enhanced magnetic resonance angiography: a prospective, intra-individual comparative analysis with digital subtraction angiography. Stroke 2005; 36:38-43 https://doi.org/10.1161/01.STR.0000149616.41312.00
  28. Nael K, Villablanca JP, Pope WB, McNamara TO, Laub G, Finn JP. Supraaortic arteries: Contrast-enhanced mr angiography at 3.0 t-highly accelerated parallel acquisition for improved spatial resolution over an extended field of view. Radiology 2007;242:600-609 https://doi.org/10.1148/radiol.2422051784
  29. Fink C, Puderbach M, Ley S, Plathow C, Bock M, Zuna I et al. Contrast-enhanced three-dimensional pulmonary perfusion magnetic resonance imaging: Intraindividual comparison of 1.0 m gadobutrol and 0.5 m gd-dtpa at three dose levels. Invest RadioI 2004;39:143-148 https://doi.org/10.1097/01.rli.0000101482.79137.f4