대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제78권4호
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  • Pages.249-258
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  • 2018
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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두개내 동맥의 형태학적 특성이 비심인성 색전 뇌경색 발생 위험에 미치는 추가적 예후 가치

The Added Prognostic Value of Intracranial Artery Morphology to Predict Non-Cardioembolic Ischemic Stroke

  • 한나혜 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 장진희 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 변호균 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 이기정 (가톨릭대학교 의과대학 서울성모병원 신경과) ;
  • 구자성 (가톨릭대학교 의과대학 서울성모병원 신경과) ;
  • 최현석 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 정소령 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 안국진 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 김범수 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Han, Na Hye (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jang, Jinhee (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Byun, Hokyun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kijeong (Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Koo, Jaseong (Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Hyun Seok (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung, So-Lyung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Kook-Jin (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-soo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2017.05.24
  • 심사 : 2017.10.21
  • 발행 : 2018.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 두개내 동맥의 형태학적 특성이 비심인성 색전 뇌경색 발생 위험에 미치는 추가적 예후 가치를 분석하고자 하였다. 대상과 방법: 후향적 연구를 시행하였으며, 급성 뇌경색이 없으면서 유체 속도 강조 자기공명 혈관조영술(time-of-flight magnetic resonance angiography; 이하 TOF-MRA)을 포함한 3T 자기공명영상을 시행한 86명의 환자가 등록되었다. 환자들은 첫 자기공명영상 시행 이후 > 120일 뒤에 확산강조영상(diffusion-weighted imaging; 이하 DWI)을 포함한 추적검사를 시행하였다. TOF-MRA에서 두개내 동맥의 확장, 협착, 사행의 세 가지 형태학적 특성을 분석하고 추적 DWI에서 급성 허혈성 뇌경색 여부를 평가하여 두 가지 예측 모형을 만들었다. 모형 1은 전통적 뇌경색 위험인자를, 모형 2는 이와 두개내 동맥의 형태학적 특성을 포함하였다. 두 모형 비교에 우도비 검정(likelihood-ratio)을 사용하였고, 모형의 성능은 Harrell의 일치 지수로 평가하였다. 결과: 14명의 환자가 비심인성 색전 뇌경색으로 진단되었고, 두 모형의 성능은 비심인성 색전 뇌경색 발생 위험 예측에 있어서 유의한 차이를 보였다(p = 0.031). Harrell의 일치 지수는 모형 2 ($0.78{\pm}0.05$)가 모형 1 $0.72{\pm}0.07$)보다 높았다. 결론: 전통적 뇌경색 위험인자와 더불어, 두개내 동맥의 형태학적 특성은 비심인성 색전 뇌경색 발생 위험 예측에 있어서 유용하다.

Purpose: To assess the added prognostic value of the morphologic characteristics of intracranial arteries in the risk modeling of a future non-cardioembolic stroke. Materials and Methods: This retrospective study included 86 patients without acute ischemic stroke who first underwent magnetic resonance imaging (MRI) including the time-of-flight magnetic resonance angiography (TOF-MRA) at 3T. Diffusion-weighted imaging (DWI) was performed for the follow-up imaging of these patients > 120 days after the initial MRI. The TOF-MRA result was used to analyze three morphological characteristics: dilatation, stenosis, and tortuosity. The presence of acute ischemic stroke was assessed using the follow-up DWI data. We built two prognostic models: model 1 includes the conventional stroke-risk factors, while model 2 includes the conventional risk factors and the morphologic characteristics of the intracranial arteries. We used the likelihood-ratio test to compare these two models. The models' performances were evaluated using Harrell's concordance index. Results: Fourteen patients suffered non-cardioembolic strokes. The performances of the two models differed significantly regarding the future-risk modeling of the non-cardioembolic stroke (p = 0.031). The Harrell's concordance index of model 2 ($0.78{\pm}0.05$) exceeded that of model 1 ($0.72{\pm}0.07$). Conclusion: In addition to the conventional stroke-risk factors, the morphologic characteristics of the intracranial arteries were useful in the modeling of the future risk of the non-cardioembolic ischemic stroke.

키워드

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