Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Visualization of Borderline Coronary Artery Lesions by CT Angiography and Coronary Artery Disease Reporting and Data System

관상동맥 질환 판독과 자료 체계와 CT 혈관조영술에서의 경계성 관상동맥 병변

  • Hyewon Park (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University) ;
  • Yu-Whan Oh (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University) ;
  • Ki Yeol Lee (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Hwan Seok Yong (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Cherry Kim (Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University) ;
  • Sung Ho Hwang (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University)
  • 박혜원 (고려대학교 의과대학 안암병원 영상의학과) ;
  • 오유환 (고려대학교 의과대학 안암병원 영상의학과) ;
  • 이기열 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 용환석 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 김채리 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 황성호 (고려대학교 의과대학 안암병원 영상의학과)
  • Received : 2023.11.19
  • Accepted : 2024.03.20
  • Published : 2024.03.01
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Abstract

Coronary artery disease (CAD) narrows vessel lumens at the sites of atherosclerosis, increasing the risk of myocardial ischemia or infarction. Early and accurate diagnosis of CAD is crucial to significantly improve prognosis and management. CT angiography (CTA) is a noninvasive imaging technique that enables assessment of vascular structure and stenosis with high resolution and contrast. Coronary CTA is useful in the diagnosis of CAD. Recently, the CAD-reporting and data system (CAD-RADS), a diagnostic classification system based on coronary CTA, has been developed to improve intervention efficacy in patients suspected of CAD. While the CADRAD is based on CTA, it includes borderline categories where interpreting the coronary artery status solely based on CTA findings may be challenging. This review introduces CTA findings that fall within the CAD-RADS categories that necessitate additional tests to decide to perform invasive coronary angiography and discusses appropriate management strategies.

관상동맥 질환은 죽상동맥경화(atherosclerosis)로 인해 혈관의 내강이 좁아지면서 심근허혈 또는 경색까지 유발할 수 있는 질병이다. 이런 관상동맥 질환은 조기에 진단해서 치료하면 그만큼 예후가 좋기에 정확한 진단이 환자 관리에서 매우 중요하다. 전산화단층촬영 혈관조영술(CT angiography; 이하 CTA)은 높은 해상도와 대조도를 통해 혈관의 구조 및 협착 정도를 세밀하게 평가할 수 있는 비침습적 영상 진단법이다. 여러 임상시험들이 관상동맥 질환에 대한 조기 진단과 평가에 있어 관상동맥 CTA의 유용성을 보고하였다. 최근에 관상동맥 질환이 의심되는 환자들에 대한 보다 효과적인 처치를 위해 CTA에 기반한 관상동맥 질환 진단 분류 체계인 관상동맥 질환 판독과 자료 체계(coronary artery disease-reporting and data system; 이하 CAD-RADS)가 만들어졌다. 이런 CAD-RADS는 관상동맥 CTA를 기반으로 하지만 CAD-RADS는 CTA 결과만으로 관상동맥의 정확한 상태를 해석하는 것이 어려운 경계선 범주를 포함하고 있다. 본 종설은 침습적 관상동맥 조영술 진행 여부를 결정하기에 앞서 추가검사가 필요한 경계선상 CAD-RADS범주들의 CTA의 소견과 이들에 대한 대처를 논하고자 한다.

Keywords

Acknowledgement

This research was technically supported by the Korea University Advanced Medical Imaging (AMI) Institute.

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