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

  • 제19권7호
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  • Pages.239-244
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  • 2018
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
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척추동맥폐색의 기전 확인에서 고해상도MRI의 유용성:증례 보고

Usefulness of High Resolution MRI in Confirmation of Mechanism:A Case Report

  • 허욱 (조선대학교의과대학 신경과학교실) ;
  • 강현구 (조선대학교의과대학 신경과학교실)
  • Hur, Wook (Department of Neurology, Chosun University School of Medicine) ;
  • Kang, Hyun Goo (Department of Neurology, Chosun University School of Medicine)
  • 투고 : 2018.05.23
  • 심사 : 2018.07.06
  • 발행 : 2018.07.31
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초록

뇌경색의 주요 원인인 동맥 박리와 죽상경화증으로 인한 동맥 폐색 모두 고식적 자기공명혈관조영술이나 컴퓨터단층혈관조영술에서 혈관이 막힌 것처럼 보이지만, 발생 기전이 다르기 때문에 치료 방향에 차이가 생길 수 있다. 최근 고해상도MRI가 발달하면서 비침습적으로 혈관벽의 영상을 확인할 수 있게 되었다. 임상적으로 혹은 영상학적으로 동맥 박리가 의심되는 환자에게 고해상도MRI는 매우 유용한 검사방법으로 자리 잡고 있으나, 아직 두 질환의 감별점이 완전히 적립 되지는 않았다. 저자들은 컴퓨터단층혈관조영술에서 척추동맥폐색이 관찰된 두 환자에서 고해상도MRI를 통해 척추동맥박리와 죽상경화증의 차이점을 찾아보았고, 이를 추적 관찰하였다. 지금까지 알려진 혈관벽의 형태, 내막 판, 이중 내막, 혈관벽내 혈종, 가성 동맥류, 동맥벽의 초승달 모양 고신호 강도와 같은 동맥박리의 특징뿐만 아니라 저자들이 경험한 증례와 같이 긴 협착 길이, 폐쇄 부위 혈관의 재개통도 동맥 박리를 시사하는 소견이라고 판단하였다. 고해상도MRI를 통해 확인된 추가적인 동맥박리의 특징과 함께 향후 다양한 연구들을 통해 진단 기준이 명확해 진다면 치료에 많은 도움을 줄 수 있을 것으로 생각한다.

Both arterial dissection and atherosclerosis are major causes of cerebral infarction and appear to be occlusion or stenosis in magnetic resonance angiography(MRA) and computed tomographic angiography(CTA). But there are differences in treatment because they have different mechanisms. Recently, as high resolution magnetic resonance image(HR-MRI) develops, the image of blood vessel wall can be confirmed non-invasively. Though HR-MRI has become a very useful method for patients with suspected arterial dissection, differential diagnosis of the two diseases has not yet been fully established due to differences in the findings according to stages of arterial dissection and atherosclerosis. We investigated the differences between vertebral artery dissection and atherosclerosis through HR-MRI in two patients and confirmed the diagnosis by CTA follow-up. In addition to the previously established diagnostic criteria, we determined that the long and severe stenosis and recanalization suggest arterial dissection. Characteristics of arterial dissection confirmed by HR-MR and additional studies will be helpful for the treatment.

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참고문헌

  1. MF Rafay, D Armstrong, G Deveber, "Craniocervical arterial dissection in children: clinical and radiographic presentation and outcome", J Child Neurol, 21:8-16, 2006. https://doi.org/10.1177/08830738060210010101
  2. S Chabrier, P Lasjaunias, B Husson, "Ischaemic stroke from dissection of the craniocervical arteries in childhood: report of 12 patients", Eur J Paediatr Neurol, 7(1):39-42, 2003. https://doi.org/10.1016/S1090-3798(02)00138-1
  3. C Amlie-Lefond, T J. Bernard, G Sebire, "Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study", Circulation, 119(10): 1417-1423, 2009. https://doi.org/10.1161/CIRCULATIONAHA.108.806307
  4. K. Takano, S. Yamashita, K. Takemoto, T. Inoue, Y. Kuwabara, K. Yoshimitsu, "MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbospin-echo sequence", Neuroradiology, 55: 845-851, 2013. https://doi.org/10.1007/s00234-013-1183-4
  5. O. Naggara, E. Touze, R. Marsico, X. Leclerc, T. Nguyen, JL Mas, "High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection", European Radiology, 19: 2255-60, 2009. https://doi.org/10.1007/s00330-009-1415-5
  6. J. E. Park, S. C. Jung, S. H. Lee, Jeon, J. Y. Lee, H. S. Kim, C. G. Choi, S. J. Kim, D. H. Lee, S. O. Kim, S. U. Kwon, D. W. Kang, J. S. Kim, "Comparison of 3D magnetic resonance imaging and digital subtraction angiography for intracranial artery stenosis", Eur Radiol. 27(11): 4737-4746, Nov. 2017. DOI: https://doi.org/10.1007/s00330-017-4860-6
  7. C. Yuan, LM Mitsumori, KW Beach, KR Maravilla, "Carotid atherosclerotic plaque: noninvasive MR characterization terization and identification of vulnerable lesions", Radiology, 221: 285-99, 2001. https://doi.org/10.1148/radiol.2212001612
  8. Y. J. Choi, S. C. Jung, D. H. Lee, "Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries", Journal of Stroke, 17(3): 238-255, 2015. https://doi.org/10.5853/jos.2015.17.3.238
  9. JF Barrett, N Keat, "Artifacts in CT: Recognition and avoidance", Radiographics, 24: 1679-91. 9, 2004. https://doi.org/10.1148/rg.246045065
  10. JM Provenzale, B Sarikaya, "Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature", AJR Am J Roentgenol, 193(4): 1167-74, Oct. 2009. https://doi.org/10.2214/AJR.08.1688
  11. TJ Kaufmann, J 3rd Huston, JN Mandrekar, CD Schleck, KR Thielen, DF Kallmes, "Complications of diagnostic cerebral angiography: evaluation of 19, 826 consecutive patients", Radiology, 243: 812-9, 2007. https://doi.org/10.1148/radiol.2433060536
  12. KH Ferdinand, Z Xianjin, EJ Stephen, U Ken, AB Jennifer, SH M, L Xin, Wei-J, "Early experience in high-resolution MRI for large vessel occlusions", J Neurointerv Surg. 7(7):509-16, Jul. 2015. https://doi.org/10.1136/neurintsurg-2014-011142
  13. O. Naggara, F Louillet, E Touze, D Roy, X Leclerc, JL Mas, "Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection", AJNR American Journal of Neuroradiology, 31: 1707-12, 2010. https://doi.org/10.3174/ajnr.A2165
  14. J Kobayashi, T Ohara, M Shiozawa, K. Minematsu, K. Nagatsuka, K. Toyoda, "Isolated posterior inferior cerebellar artery dissection as a cause of ischemic stroke: clinical features and prognosis", Cerebrovasc Dis, 40: 215-221, 2015. https://doi.org/10.1159/000439145
  15. Y. J. Choi, S. C. Jung, D. H. Lee, "Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries", Journal of Stroke. 17(3):238-255, 2015. https://doi.org/10.5853/jos.2015.17.3.238
  16. JT Mehigan, C Olcott, "The carotid "string" sign. Differential diagnosis and management", Am J Surg, 140:137-143, 1980. https://doi.org/10.1016/0002-9610(80)90430-4
  17. JL Mas. MG Bousser, D Hasboun, "Extracranial vertebral artery dissection: a review of 13 cases", stroke; 18; 1037-1047, 1987. DOI: https://doi.org/10.1161/01.STR.18.6.1037
  18. A Arauz, J Manuel M, C Artigas, Jorge Balderrama, Hector Orrego, "Recanalization of Vertebral Artery Dissection", Stroke, 41:717-721, 2010. https://doi.org/10.1161/STROKEAHA.109.568790
  19. M Han, NJ Rim, JS Lee, SY Kim, JW Choi, "Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection", European Radiology, 24: 3017-24, 2014. https://doi.org/10.1007/s00330-014-3296-5
  20. C. W. Ryu, H. S. Kwak, G. H. Jahng, H. N. Lee, "High resolution MRI of intracranial atherosclerotic disease", Neurointervention, 9: 9-20, 2014. https://doi.org/10.5469/neuroint.2014.9.1.9
  21. K. J. Park, S. C. Jung, H. S. Kim, C. G. Choi, S. J. Kim, D. H. Lee, "Multi-contrast high-resolution magnetic resonance findings of spontaneous and unruptured intracranial vertebral artery dissection: Qualitative and quantitative analysis according to stages", Cerebrovascular Diseases (Basel, Switzerland), 42: 23-31, 2016. https://doi.org/10.1159/000444315