• Clinical and Experimental Pediatrics
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• 제60권8호
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• pp.237-244
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• 2017

During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

• Korean Journal of Radiology
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• 제22권10호
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• pp.1619-1627
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• 2021

Objective: This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). Materials and Methods: This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. Results: The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m² for PA, 75.9 ± 14.3 mL/m² for EH, and 77.3 ± 12.8 mL/m² for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m² for PA, 30.7 ± 8.1 mL/m² for EH, and 29.5 ± 7.0 mL/m² for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m² for PA, 56.9 ± 12.1 g/m² for EH, and 44.1 ± 8.9 g/m² for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosterone-to-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. Conclusion: Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.

• Investigative Magnetic Resonance Imaging
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• 제17권3호
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• pp.200-206
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• 2013

목적: 자기공명 심장영상을 이용한 좌심실 파라미터 측정에 있어, 자동화 방식을 적용하였을 경우에 나타나는 효과를 분석하고 이를 수동 및 반자동 방식을 적용했을 경우 나타나는 결과와 비교하였다. 대상과 방법: 1.5T 자기공명 심장영상 촬영을 시행한 62명의 환자를 대상으로, 심장 주기당 20상의 단축 항정상태 자유세차 동영상과 심첨2방 및 심첨4방 영상을 얻었다. 심내막 경계와 심외막 경계를 수동, 자동, 반자동 방식으로 각각 구하여 이를 바탕으로 이완말기와 수축말기 용적, 박출 계수, 일회 박출량, 좌심실 질량을 계산하고 각 방식간 평균값 차이를 일원분산분석법을 이용 통계적 분석하였다. 결과: 이완말기와 수축말기 용적의 경우에는 세 방식으로 측정한 결과는 통계적으로 유의하게 다르지 않았다. (P = .399 and .145). 그러나, 박출 계수, 일회 박출량, 좌심실 질량의 경우에는 통계적으로 유의하게 다르게 나타났으며 (P=.001, < 001, < 001) 자동화 방식으로 측정한 측정치가 다른 두 방식에 비해 일관되게 큰 결과치를 보였다. 결론: 자동화 방식을 적용하여 측정한 좌심실의 박출 계수, 일회 박출량, 좌심실 질량의 측정치는 수동, 반자동 방식에 비해 과장된 값을 나타낸다. 자동화 방식으로 많은 노력을 절감할 수 있으나, 임상적으로 민감한 케이스에 대해서는 이에 더하여 수동적 교정을 고려해야 할 것이다.

• Korean Journal of Radiology
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• 제23권12호
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• pp.1251-1259
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• 2022

Objective: T1 mapping provides valuable information regarding cardiomyopathies. Manual drawing is time consuming and prone to subjective errors. Therefore, this study aimed to test a DL algorithm for the automated measurement of native T1 and extracellular volume (ECV) fractions in cardiac magnetic resonance (CMR) imaging with a temporally separated dataset. Materials and Methods: CMR images obtained for 95 participants (mean age ± standard deviation, 54.5 ± 15.2 years), including 36 left ventricular hypertrophy (12 hypertrophic cardiomyopathy, 12 Fabry disease, and 12 amyloidosis), 32 dilated cardiomyopathy, and 27 healthy volunteers, were included. A commercial deep learning (DL) algorithm based on 2D U-net (Myomics-T1 software, version 1.0.0) was used for the automated analysis of T1 maps. Four radiologists, as study readers, performed manual analysis. The reference standard was the consensus result of the manual analysis by two additional expert readers. The segmentation performance of the DL algorithm and the correlation and agreement between the automated measurement and the reference standard were assessed. Interobserver agreement among the four radiologists was analyzed. Results: DL successfully segmented the myocardium in 99.3% of slices in the native T1 map and 89.8% of slices in the post-T1 map with Dice similarity coefficients of 0.86 ± 0.05 and 0.74 ± 0.17, respectively. Native T1 and ECV showed strong correlation and agreement between DL and the reference: for T1, r = 0.967 (95% confidence interval [CI], 0.951-0.978) and bias of 9.5 msec (95% limits of agreement [LOA], -23.6-42.6 msec); for ECV, r = 0.987 (95% CI, 0.980-0.991) and bias of 0.7% (95% LOA, -2.8%-4.2%) on per-subject basis. Agreements between DL and each of the four radiologists were excellent (intraclass correlation coefficient [ICC] of 0.98-0.99 for both native T1 and ECV), comparable to the pairwise agreement between the radiologists (ICC of 0.97-1.00 and 0.99-1.00 for native T1 and ECV, respectively). Conclusion: The DL algorithm allowed automated T1 and ECV measurements comparable to those of radiologists.

• Korean Journal of Radiology
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• 제20권1호
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• pp.83-93
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• 2019

Objective: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77-0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = -0.61, p < 0.001) and changes in EF (β = -0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17-0.85; p = 0.019). Conclusion: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.

• Korean Journal of Radiology
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• 제24권9호
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• pp.838-848
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• 2023

Objective: To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). Materials and Methods: A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. Results: Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m² vs. 78.9 g/mm²; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01-1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. Conclusion: Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.

• Journal of Yeungnam Medical Science
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• 제4권1호
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• pp.1-15
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• 1987

Magnetic Resonance (M.R.) is rapidly emerging technique that provides high quality images and potentially provides much more diagnostic information than do conventional imaging modalities. M.R.I. is conceptually quite different from currently used imaging methods. The complex nature of M.R.I. allows a great deal of flexibility in image product ion and available information, and key points are as follows. 1. M.R.I. offers a non-invasive technique with which to gene rate in vivo human images without ionizing radiation and with no known adverse biological effects. 2. Imaging mechanism of M.R.I. is quite different from conventional imaging modality and for more accurate diagnostic application, It is necessary for physician to understand imaging mechanism of M.R.I. 3. M.R. makes available basic chemical parameters that may provide to be useful for diagnostic medical imaging and more specific pathophysiologic information which are not available by alternate techniques. 4. M.R. can be produced by number of different methods. This flexibility allows the imaging technique to be applicated for particular clinical purpose. Multiplanar and three dimensional imaging may extend the imaging process beyond the single section available with current CT. 5. Future directions include efforts to; a. Further development of hard ware b. More fasternning scan time c. Respiratory and cardiac gated imaging d. Imaging of additional nuclei except hydrogen e. Further development of contrast media f. M.R. in vivo spectroscopy g. Real time M.R. imaging.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.143-147
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• 2018

Background: Hypoglycemia is uncommon in people without diabetes. There have been only a few reports of cardiac arrest in conjunction with hypoglycemia in non-diabetic patients. Case Report: A 66-year-old man visited the emergency room with dizziness. He was a chronic alcoholic. Laboratory test showed no evidence of diabetes mellitus. Brain magnetic resonance imaging revealed a left cerebellar infarction. Abdomen computed tomography demonstrated liver cirrhosis with minimal ascites. During his hospital stay, he consumed only a small amount of food because of nausea and headache. On hospital day 4, he had a cardiac arrest after two seizure episodes. His blood glucose was 10 mg/dL. The combination of liver cirrhosis, renal failure and poor oral intake was presumed to be the causes of the severe hypoglycemia. Conclusion: We report a rare case of cardiac arrest occurring in conjunction with severe hypoglycemia in a non-diabetic patient with cerebral infarction.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2002년도 제7차 학술대회 초록집
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• pp.134-134
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• 2002

목적： 심근경색의 가역성 여부 판단시 cardiac MR imaging(CMRI)와 myocardial SPECT의 정확성을 비교하기 위하여 대상 및 방법： 흉통을 주소로 내원한 환자 중 CMRI와 SPECT를 시행한 17를 대상으로 역행적으로 조사하였다. CMRI는 double and triple inversion recovery image(IR)에서 심벽의 고신호강도, 2D-FIESTA에서 심기능 분석을 조사하였다. 이어 gadopentetate를 주입하여 확산스캔에서 확산결손을 조사하였다. 연속하여 gadopentetate를 더 주입 후 5분 후 지연심근강조영상을 얻어 지연조영증강 유무와 미세혈류 폐쇄를 조사하였다. SPECT는 아데노신으로 stress 스캔을 얻은 후 T1-201을 재주사 후 rest 스캔하여 확산결손과 재분배를 조사하여 가역성을 판단하였다.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1305-1316
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• 2020

In approximately 10% of patients with acute myocardial infarction (MI), angiography does not reveal an obstructive coronary stenosis. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA), which has complex and multifactorial causes. However, this term can be confusing and open to dual interpretation, because MINOCA is also used to describe patients with acute myocardial injury caused by ischemia-related myocardial necrosis. Therefore, with regards to this specific context of MINOCA, the generic term for MINOCA should be replaced with troponin-positive with non-obstructive coronary arteries (TpNOCA). The causes of TpNOCA can be subcategorized into epicardial coronary (causes of MINOCA), myocardial, and extracardiac disorders. Cardiac magnetic resonance imaging can confirm MI and differentiate various myocardial causes, while cardiac computed tomography is useful to diagnose the extracardiac causes.