[국내논문]뇌경색에서 확산강조영상과 비교하여 현성확산계수 지도의 부가적인 임상적 중요성이 있는가? Does the ADC Map have Additional Clinical Significance Compared to the DWI in the Brain Infarction?원문보기
목적: 뇌경색의 시기판단에 있어서 현성확산계수 지도의 부가적인 임상적 중요성을 다시 평가하기 위하여, 확산 강조영상과 현성확산계수 지도에서 뇌경색의 시간경과에 따른 변화 양상의 차이가 있는지 알고자 한다. 대상과 방법: 뇌경색 환자 127명의 199회 자기공명영상 검사를 대상으로 하였으며, 시간을 기준으로(117 검사), 날짜를 기준으로 (108 검사), 주수를 기준으로 (62 검사) 그룹을 나누었다. 확산 강조영상과 현성확산계수 지도에서 뇌경색의 중심부와 대측부위를 관심영역 0.3 $cm^2$ 이상으로 하여 신호 강도를 측정하여, 경색부위/대측정상부위의 비 (ratio)를 구하여 각 그룹에서 시간 경과에 따른 변화양상을 비교관찰하였다. 결과: 뇌경색은 발생 1시간 이내부터 영상에서 관찰되었으며, 확산강조영상에서 신호강도비는 12시간 이후에 2 이상으로 되어 6일까지 유지되다가 점차 감소하여 발생 30일경에 1로 감소 하였다. 현성확산계수비는 발생 24시간에 0.46 이었으며, 15일경에 1로 증가하였다. 뇌경색의 시간 경과에 따른 비의 곡선은 서로 역의 관계인 대칭적인 양상을 보였다. 결론: 확산강조영상과 현성확산계수 지도에서 뇌경색의 시간경과에 따른 변화양상은 역의 관계로서 현성확산계수 값은 확산강조영상으로부터 예측 가능하며, 현성확산계수 지도는 확산강조영상과 함께 판단하면 15-30일 사이의 아급성기 뇌경색의 진단에 도움이 될 수 있을 것이다.
목적: 뇌경색의 시기판단에 있어서 현성확산계수 지도의 부가적인 임상적 중요성을 다시 평가하기 위하여, 확산 강조영상과 현성확산계수 지도에서 뇌경색의 시간경과에 따른 변화 양상의 차이가 있는지 알고자 한다. 대상과 방법: 뇌경색 환자 127명의 199회 자기공명영상 검사를 대상으로 하였으며, 시간을 기준으로(117 검사), 날짜를 기준으로 (108 검사), 주수를 기준으로 (62 검사) 그룹을 나누었다. 확산 강조영상과 현성확산계수 지도에서 뇌경색의 중심부와 대측부위를 관심영역 0.3 $cm^2$ 이상으로 하여 신호 강도를 측정하여, 경색부위/대측정상부위의 비 (ratio)를 구하여 각 그룹에서 시간 경과에 따른 변화양상을 비교관찰하였다. 결과: 뇌경색은 발생 1시간 이내부터 영상에서 관찰되었으며, 확산강조영상에서 신호강도비는 12시간 이후에 2 이상으로 되어 6일까지 유지되다가 점차 감소하여 발생 30일경에 1로 감소 하였다. 현성확산계수비는 발생 24시간에 0.46 이었으며, 15일경에 1로 증가하였다. 뇌경색의 시간 경과에 따른 비의 곡선은 서로 역의 관계인 대칭적인 양상을 보였다. 결론: 확산강조영상과 현성확산계수 지도에서 뇌경색의 시간경과에 따른 변화양상은 역의 관계로서 현성확산계수 값은 확산강조영상으로부터 예측 가능하며, 현성확산계수 지도는 확산강조영상과 함께 판단하면 15-30일 사이의 아급성기 뇌경색의 진단에 도움이 될 수 있을 것이다.
Purpose : To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. Materials and Methods: In 127 patients with cerebral infarctions,...
Purpose : To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. Materials and Methods: In 127 patients with cerebral infarctions, including follow-up checks, 199 studies were performed. They were classified as hourly (117 studies)-, daily (108 studies)-, weekly (62 studies)-based groups. The signal intensity (SI) was measured at the core of the infarction and contralateral area with ROI of 0.3 $cm^2$ or more on the images of the DWI and the ADC map, and calculated the ratios of SI and ADC value of the infarction area / contralateral normal area, and compared the patterns of the change according to the evolution. Results: Infarction was detected as early as 1 hour after the attack, and the ratio of SI in the DWI became over than 2 after 12 hours, which showed a plateau until the 6th day. Thereafter, it decreased slowly to 1 on the 30th day, and changed to lower SI than the surrounding brain. The ratio in the ADC map became 0.46 in 24 hours after the attack, and increased slowly to 1 in the 15th day. Thereafter, it became a higher value than the surrounding brain. Overall, the ratio in the ADC map changed earlier than in the DWI, and the ratio curves showed inverse pattern each other according to the evolution of the infarction. Conclusion: The evolution patterns of infarction on the ADC map showed an inverse curve of DWI curve, which means that the ADC value is accurately predictable from DWI, and the ADC map joined with the DWI seems helpful in the determination of subacute infarction between 15 to 30 days.
Purpose : To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. Materials and Methods: In 127 patients with cerebral infarctions, including follow-up checks, 199 studies were performed. They were classified as hourly (117 studies)-, daily (108 studies)-, weekly (62 studies)-based groups. The signal intensity (SI) was measured at the core of the infarction and contralateral area with ROI of 0.3 $cm^2$ or more on the images of the DWI and the ADC map, and calculated the ratios of SI and ADC value of the infarction area / contralateral normal area, and compared the patterns of the change according to the evolution. Results: Infarction was detected as early as 1 hour after the attack, and the ratio of SI in the DWI became over than 2 after 12 hours, which showed a plateau until the 6th day. Thereafter, it decreased slowly to 1 on the 30th day, and changed to lower SI than the surrounding brain. The ratio in the ADC map became 0.46 in 24 hours after the attack, and increased slowly to 1 in the 15th day. Thereafter, it became a higher value than the surrounding brain. Overall, the ratio in the ADC map changed earlier than in the DWI, and the ratio curves showed inverse pattern each other according to the evolution of the infarction. Conclusion: The evolution patterns of infarction on the ADC map showed an inverse curve of DWI curve, which means that the ADC value is accurately predictable from DWI, and the ADC map joined with the DWI seems helpful in the determination of subacute infarction between 15 to 30 days.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
문제 정의
And so, this study was designed to re-evaluate the additional clinical significance of ADC map compared to the DWI in the inference of infarction stage by the observation of the patterns of infarction evolution on the DWI and ADC map.
And also, previous reports have some weak points like as not enough observation time courses in detail, not enough time duration and not many study case numbers. This study was designed to know the pattern of evolutions of the DWI and the ADC map of the infarction to know the additional clinical significance of the ADC map compared to the DWI in detail.
제안 방법
3. The evolution curves of average rSIDWI and rADC by hourly-based analysis; Curves show the SI on the DWI is increasing and the SI on the ADC map is decreasing continuously during first 24 hours.
대상 데이터
1. Example of ROI measurement; DWI (left) and ADC map (right) in a 68-year-old woman examined 46 hours after stroke onset. Note the ROIs placed on the lesion and contralateral normalappearing hemisphere.
성능/효과
In the hourly-based analysis, the rSIDWI increased to 1.29 within one hour, and continuously increased to 2.13 at 24 hours, and the rADC decreased to 0.73 within one hour, and continuously decreased to 0.47 at 24 hours after stroke onset (Figs. 2, 3). In the dailybased analysis, the rSIDWI was 2.
In summary, the rSIDWI was peaked with 2.22 in the 6th day, decreased to 1.02 in the 30th day, and the rADC showed the lowest value with 0.46 in 24 hours after stroke onset, and increased to 1.03 which means isointense SI or pseudonormalization in the 15th day, and the evolution pattern of SI on the ADC map is inversely correlated with the DWI.
참고문헌 (13)
van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LMP, Mali WPTM. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 1998;29:1783-1790
Lansberg MG, Thijs VN, O'Brien MW, et al. Evolution of apparent diffusion coefficient, diffusion-weighted, and T2- weighted signal intensity of acute stroke. AJNR Am J Neuroradiol 2001;22:637-644
Barajas RF, Rubenstein JL, Chang JS, Hwang J, Cha S. Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol 2010; 131:60-66
Desmond PM, Lovell AC, Rawlinson AA, et al. The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR Am J Neuroradiol 2001; 22: 1260-1267
Rana AK, Wardlaw JM, Armitage PA, Bastin ME. Apparent diffusion coefficient (ADC) measurements may be more reliable and reproducible than lesion volume on diffusion-weighted images from patients with acute ischemic stroke; implications for study design. J Magn Reson Imaging 2003;21:617-624
Oppenheim C, Grandin C, Samson Y, et al. Is there an apparent diffusion coefficient threshold in predicting tissue viability in hyperacute stroke? Stroke 2001;32:2486-2491
Sibon I, Menegon P, Orgogozo JM, et al. Inter- and intraobserver reliability of five MRI sequences in the evaluation of the final volume of cerebral infarct. J Magn Reson Imaging 2009; 29:1280-1284
Na DK, Thijs VN, Albers GW, Moseley ME, Marks MP. Diffusion-weighted MR imaging in acute ischemia: Value of apparent diffusion coefficient and signal intensity thresholds in predicting tissue at risk and final infarct size. AJNR Am J Neuroradiol 2004;25:1331-1336
Eastwood JD, Engelter ST, MacFall JF, Delong DM, Provenzale JM. Quantitative assessment of the time course of infarct signal intensity on diffusion-weighted images. AJNR Am J Neuroradiol 2003;24:680-687
Yang Q, Tress BM, Barber PA, et al. Serial study of apparent diffusion coefficient and anisotropy in patients with acute stroke. Stroke 1999;30:2382-2390
Copen WA, Schwamm LH, Gonzalez RG, et al. Ischemic stroke: effects of etiology and patient age on the time course of the core apparent diffusion coefficient. Neuroradiology 2001;221:27-34
Burdette JH, Ricci PE, Petitti N, Elster AD. Cerebral infarction: time course of signal intensity changes on diffusion-weighted MR images. AJR Am J Roentgenol 1998;171:791-795
※ AI-Helper는 부적절한 답변을 할 수 있습니다.