• 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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• 제22권3호
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• pp.308-323
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• 2021

An increasing number of adult congenital heart disease (ACHD) patients continue to require life-long diagnostic imaging surveillance using cardiac CT and MRI. These patients typically exhibit a large spectrum of unique anatomical and functional changes resulting from either single- or multi-stage palliation and surgical correction. Radiologists involved in the diagnostic task of monitoring treatment effects and detecting potential complications should be familiar with common cardiac CT and MRI findings observed in patients with repaired complex ACHD. This review article highlights the contemporary role of CT and MRI in three commonly encountered repaired ACHD: repaired tetralogy of Fallot, transposition of the great arteries after arterial switch operation, and functional single ventricle after Fontan operation.

• 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.

• 한국방사선학회논문지
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• 제15권7호
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• pp.975-982
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• 2021

본 연구는 체내의 식도용 스텐트와 일플란트에 많이 사용되는 티타늄 성분의 금속성 물질을 사용하여 구리와 black metal, polyester로 구성된 머리카락 보다 가늘게 제작된 mesh로 시험관을 부분적으로 RF를 차폐하여 주변에 위치한 자기공명영상용 팬텀에 미치는 영향을 평가하고자 하였다. 3T Achieva X-series의 Cardiac Coil을 사용하여 TR 500 ms, TE 20 ms, NEX 1, slice thickness 5 mm의 Spin Echo T1강조영상에서 field of view(FOV)에 따른 자기공명영상을 분석하였다. FOV 304 mm × 304 mm에서는 발생하지 않았던 aliasing artifact가 발생하지 않았지만 250 mm × 250 mm 과 170 mm × 170 mm에서는 발생되었다. FOV 170 mm × 170 mm에서 mesh를 사용하지 않은 경우는 SNR이 78.23으로 가장 낮았으며, mesh를 가운데 세워 분리한 경우에는 215.05, mesh로 완전히 차폐한 경우에는 366.44로 높게 측정되었다. 또한 mesh로 완전히 감싸고 차폐한 경우에는 aliasing artifact도 제거되었고, 영상의 왼쪽과 가운데, 오른쪽의 신호 대 잡음비가 높으면서 다른 조건과 비교하여 균질한 영상을 획득할 수 있었다. 결론적으로 mesh로 RF를 부분적으로 감싸고 차단하면 aliasing artifact를 제거할 수 있고, 작은 FOV를 사용하여 영상의 해상도와 균질성이 우수한 자기공명영상을 획득할 수 있을 것으로 사료된다.

• Investigative Magnetic Resonance Imaging
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• 제16권2호
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• pp.189-194
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• 2012

40세 남성에서 상대정맥의 폐쇄와 우폐동맥 협착을 동반한 종격동 종괴가 발견되어 병리학적 소견에 경화성 종격동염으로 진단되었고, 6개월 후 심장 자기공명영상(MRI)에서 비허혈성 심근병증으로 의심된 심장림프종의 예를 보고하고자 한다. 심장 초음파에서 제한적 양상의 심장 생리현상을 보였고 구혈율이 매우 감소되어 있었다. MRI에서 전반적인 심근비대와 조영제 주입 후 광범위한 지연조영증강이 있어 비허혈성 심근병증이 의심되었으며 심장근육 생검 후 림프종으로 확진되었다. 조영제 주입후 MRI에서 심근 기저부는 침범되지 않았고 전반적인 심내막 보존이 있었으므로 아밀로이드증과 구별되는 양상이고 종괴를 형성하지 않았기 때문에 심장종양 보다는 심근병증에 더 유사한 영상 소견을 보인 특이한 증례로서 심장림프종의 자기공명영상에서의 특징을 문헌고찰과 함께 보고하고자 한다.

• Journal of Cardiovascular Imaging
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• 제30권1호
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• pp.50-58
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• 2022

BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and -15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), -0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = -0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.