대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제65권4호
  • /
  • Pages.325-331
  • /
  • 2011
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

동맥류성 거미막밑출혈 후 발생한 뇌혈관 연축의 다중검출기 CT 혈관조영술: 골감산 및 표준기법의 CT 혈관조영술과 디지털감산혈관조영술의 비교

Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

  • 이용희 (경상대학교병원 영상의학과) ;
  • 최대섭 (경상대학교병원 영상의학과) ;
  • 유재욱 (삼성서울병원 영상의학과) ;
  • 유진종 (경상대학교병원 영상의학과) ;
  • 최호철 (경상대학교병원 영상의학과) ;
  • 김지은 (경상대학교병원 영상의학과)
  • Lee, Yong-Hee (Department of Radiology, Gyeongsang National University Hospital) ;
  • Choi, Dae-Seob (Department of Radiology, Gyeongsang National University Hospital) ;
  • Ryoo, Jae-Wook (Department of Radiology, Samsung Seoul Hospital) ;
  • You, Jin-Jong (Department of Radiology, Gyeongsang National University Hospital) ;
  • Choi, Ho-Cheol (Department of Radiology, Gyeongsang National University Hospital) ;
  • Kim, Ji-Eun (Department of Radiology, Gyeongsang National University Hospital)
  • 발행 : 2011.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 동맥류의 파열에 의한 거미막밑출혈(이하 SAH) 후 발생한 뇌혈관연축을 진단하는 데 있어 디지털감산혈관조영술(이하 DSA)과 비교하여 다중검출기 CT 혈관조영술(MDCTA)의 유용성을 평가하고자 하였으며, 골감산기법의 CT 혈관조영술(이하 BS-CTA)과 표준기법의 CT 혈관조영술(이하 S-CTA)을 비교하였다. 대상과 방법: 동맥류성 SAH에 의한 뇌혈관연축으로 동맥내 니모디핀 주입술을 시행한 33명의 환자를 대상으로 하였다. S-CTA 원천영상에서 조영전 CT 원천영상을 감산하여 BS-CTA영상을 재구성하였다. 총 207개의 두개내 혈관분절을 분석하였으며 DSA영상을 표준으로 하여 S-CTA와 BS-CTA영상을 분석하였다. 혈관연축의 정도를 4단계로 구분하여 평가하였고, DSA와 S-CTA 및 DSA와 BS-CTA 결과의 일치도를 구하였다. 결과: DSA 결과에서 56개의 분절(27%)에서 혈관연축이 있는 것으로 확인되었다. 협착정도의 평가에 있어 DSA와 S-CTA 및 BS-CTA 결과의 일치도는 각각 94.7%, 82.1%였다. 협착의 정도가 일치하지 않은 경우는 BS-CTA에서는 37분절 모두에서 과대평가하였고, S-CTA에서는 8분절에서는 과대평가, 4분절에서는 과소평가하였다. 결론: MDCT를 이용한 S-CTA는 동맥류성 SAH에 의한 뇌혈관연축을 진단하는데 DSA와 필적할만한 비침습적인 검사로 생각된다. 그러나 BS-CTA는 협착의 정도를 과대평가하는 경향이 있고 추가적인 방사선 노출이 따르므로 불필요한 검사로 생각된다.

Purpose: To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Materials and Methods: Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A four-step scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. Results: On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on S-CTA (n = 4). Conclusion: MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis.

키워드

참고문헌

  1. Weir B, Grace M, Hansen J, Rothberg C. Time course of vasospasm in man. J Neurosurg 1978;48:173-178 https://doi.org/10.3171/jns.1978.48.2.0173
  2. Sloan MA, Haley EC Jr, Kassell NF, Henry ML, Stewart SR, Beskin RR, et al. Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage. Neurology 1989;39: 1514-1518 https://doi.org/10.1212/WNL.39.11.1514
  3. Schwartz RB, Tice HM, Hooten SM, Hsu L, Stieg PE. Evaluation of cerebral aneurysms with helical CT: correlation with conventional angiography and MR angiography. Radiology 1994;192:717-722 https://doi.org/10.1148/radiology.192.3.8058939
  4. Anderson GB, Ashforth R, Steinke DE, Findlay JM. CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 2000;21:1011-1015
  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. Yoon DY, Choi CS, Kim KH, Cho BM. Multidetector-row CT angiography of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: comparison of volume-rendered images and digital subtraction angiography. AJNR Am J Neuroradiol 2006;27:370-377
  7. Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M. Bone-subtraction CT angiography for the evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2006;27: 55-59
  8. Watanabe Y, Uotani K, Nakazawa T, Higashi M, Yamada N, Hori Y, et al. Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography. Eur Radiol 2009;19:1019-1024 https://doi.org/10.1007/s00330-008-1213-5
  9. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 2000;21:643-646
  10. Ochi RP, Vieco PT, Gross CE. CT angiography of cerebral vasospasm with conventional angiographic comparison. AJNR Am J Neuroradiol 1997;18:265-269
  11. Chaudhary SR, Ko N, Dillon WP, Yu MB, Liu S, Criqui GI, et al. Prospective evaluation of multidetector-row CT angiography for the diagnosis of vasospasm following subarachnoid hemorrhage: a comparison with digital subtraction angiography. Cerebrovasc Dis 2008;25:144-150 https://doi.org/10.1159/000112325
  12. Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K. Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiography. Neurosurgery 2002;51:939-942; discussion 942-943
  13. Buerke B, Puesken M, Wittkamp G, Stehling C, Ditt H, Seidensticker P, et al. Bone subtraction CTA for transcranial arteries: intra-individual comparison with standard CTA without bone subtraction and TOF-MRA. Clin Radiol 2010; 65:440-446 https://doi.org/10.1016/j.crad.2010.03.002
  14. Hegde A, Chan LL, Tan L, Illyyas M, Lim WE. Dual Energy CT and its use in neuroangiography. Ann Acad Med Singapore 2009;38:817-820