Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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A study on improvement of misdiagnosis rate in aortic regurgitation disease by physically correcting EF in 2D echo cardiography

대동맥판 역류질환 진단시 이면성심초음파 박출계수의 보정을 통한 오진율 개선에 관한 연구

  • 최관우 (서울아산병원 영상의학과) ;
  • 손순룡 (서울아산병원 영상의학과)
  • Received : 2012.03.05
  • Accepted : 2012.05.10
  • Published : 2012.05.31
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Abstract

This study is aimed at decreasing wrong diagnosis with corrected EF(Ejection Fraction) of 2D echo cardiography by analysing the physical time-resolution difference between Cine MRI and 2D echo cardiography and applying the corrected EF in 2D echocardiography. From February 2010 to December 2011, among the 110 patients who had undergone both 2D echo cardiography and cine MRI only 37 patient were selected suffering aortic valve regurgitation. ED, ES and SV were measured and EF was calculated in each system while normal ranges of Cine MRI and 2D echocardiography were compared to evauate misdiagnosis rate. The correlation of physical time resolution between 2D echocardiography and MRI was evaluated and the differences were corrected with linear regression coefficient which is derived from linear regression analysis. Blandt-Altman plot was used to evaluate the reliability of corrected 2D echo cardiography EF and compare the error among measured values. The values were compared with MRI normal range and misdiagnosis rate was measured again. As a result, misdiagnosis rates of physical time resolution were measured to be 32.4%(12people) before the correction of EF and 18.9%(7people) after the correction. Also, EF confirmed in Blandt-Altman plot were almost the same with MRI EF. In conclusion, when diagnosing aortic regurgitation disease, simply using 2D echocardiography can easily raise the misdiagnosis rates, therefore considering the MRI machine's physical merits, correcting the time resolution difference is important by calculating time resolution wrong diagnosis would decrease and it is considered to be useful in clinical circumstances.

본 연구는 좌심실의 박출계수가 주된 예후인자인 대동맥판 역류환자를 대상으로 cine MRI와 이면성심초음파의 물리적인 시간해상도 차이를 분석하여 이면성심초음파의 박출계수에 보정함으로써 오진율을 감소시키고자 하였다. 연구대상은 2010년 2월부터 2011년 12월까지 이면성심초음파와 cine MRI를 병행한 환자 110명 중 대동맥판 역류환자 37명을 대상으로 하였다. 각 검사 장비별로 이완기말 면적, 수축기말 면적, 일회 심박출 면적을 측정하였으며, 측정된 값을 이용하여 박출계수를 구하고, 이면성심초음파와 cine MRI의 정상 수치 범위를 비교하여 보정 전 오진율을 평가하였다. 이면성심초음파와 cine MRI의 물리적인 시간해상도 차이는 두 측정치간의 상관관계를 알아본 후 선형회귀분석을 이용하여 회귀계수를 도출하고 도출된 회귀계수를 이용하여 이면성심초음파의 박출 계수에 보정하였다. 보정된 이면성심초음파 박출계수의 신뢰도를 평가하기 위해 Bland-Altman plot를 통해 측정치간 오차를 분석하였고, 이 수치를 cine MRI의 정상 수치 범위와 비교하여 보정 후 오진율을 재평가하였다. 연구결과, 이면성심초음파 박출계수의 물리적 시간해상도 보정 전 오진율은 32.4%(12명)로 높게 나왔고, 보정 후 오진율은 18.9%(7명)로 13.5% 감소하였다. 또한 Bland-Altman plot에서 확인한 보정된 이면성심초음파 박출계수는 cine MRI의 박출계수와의 일치도가 상당히 높다는 것을 알 수 있다. 결론적으로 대동맥판 역류질환 진단시 단순한 이면성심초음파의 박출계수로만 감별하는 것은 오진율을 높일 수 있으므로 오진율이 낮은 cine MRI장비의 물리적 특성을 고려한 시간해상도의 차이를 보정함이 중요하며, 본 연구를 통하여 오진율 감소를 확인할 수 있었으므로 임상 적용의 유용성이 높다고 사료된다.

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References

  1. Young Mi Hong, et al., "Comparison between Echocardiography and Cardiac Cine-MR: Left Ventricular Volume and Cardiac Output", Ewha Med J, 15, 4, pp. 327-336, 1992. https://doi.org/10.12771/emj.1992.15.4.327
  2. Leung MP, et al., "The management of symptomatic neonates with suspected congenital heart disease using combined cross-sectional echocardiography and pulsed doppler flow study as the definitive invesigation", Int J Cardiol, 24, pp. 41-40, 1989. https://doi.org/10.1016/0167-5273(89)90039-9
  3. Bozio A, et al., "Cardiac surgery without catheterization: Influence of color doppler flow mapping", Pediatr cardiol, 11, pp. 245, 1990.
  4. Meyer RH, et al., "Ventricular septum in right ventricular volume overload", Am J Cardiol, 30, pp. 349-353, 1972. https://doi.org/10.1016/0002-9149(72)90564-4
  5. Levine RA, et al., "Echo cardiographic measurement of right ventricular volume", Circulation, 69, pp. 497-505, 1984. https://doi.org/10.1161/01.CIR.69.3.497
  6. van der Wall EE, et al., "Magnetic resonance imaging: A new approach for evaluating coronary artery disease", Am Heart J, 121, pp. 1203-1220, 1991. https://doi.org/10.1016/0002-8703(91)90683-9
  7. Dodge HT, et al., "The use of the biplane angiography for the measurement of left ventricular volume in man", Am Heart, 60, pp. 762-776, 1960. https://doi.org/10.1016/0002-8703(60)90359-8
  8. Dehmer Gl, et al., "Non geometric determination of left ventricular volumes from equilibrium blood pool scans", Am J Cardiol, 45, pp. 293-300, 1980. https://doi.org/10.1016/0002-9149(80)90648-7
  9. Slutsky R, et al., "Left ventricular volumes by gated equilibrium radionuclide angiography: A new method", Circulation, 60, pp. 556-564, 1979. https://doi.org/10.1161/01.CIR.60.3.556
  10. Buser PT, et al., "Noninvasive evaluation of global left ventricular function with use of cine nuclear magnetic resonance", J Am Coll Cardiol, 13, pp. 1294-1300, 1989. https://doi.org/10.1016/0735-1097(89)90304-5
  11. Byrd BF, et al., "Normal cardiac dimensions by magnetic resonance imaging", Am J Cardiol, 55, pp. 1440-1442, 1985. https://doi.org/10.1016/0002-9149(85)90529-6
  12. Haase A, et al., "Flash imaging: rapid NMR imaging using low flipangle pulses", J Magn Reson, 67, pp. 258-266, 1986.
  13. Hsu YH, et al., "Magnetic resonance imaging of total anomalous pulmonary venous drainage", Am Heart J, 121, pp. 1560-1565, 1991. https://doi.org/10.1016/0002-8703(91)90174-G
  14. Marino B, et al., Pulmonary atresia with ventricular septal defect. Selection of patients for systemic to pulmonary arterial shunt based on echocardiography", Cheat, 99, pp. 158-161, 1991.