[논문]자화율강조 MR영상을 이용한 뇌정맥 기형의 진단: T2강조영상과 FLAIR영상과의 비교

조수범; 최대섭; 유현규; 신화선; 김지은; 최혜영; 박미정; 최호철; 손승남

doi:10.13104/jksmrm.2014.18.3.200

[국내논문] 자화율강조 MR영상을 이용한 뇌정맥 기형의 진단: T2강조영상과 FLAIR영상과의 비교
Susceptibility-Weighted MR Imaging for the Detection of Developmental Venous Anomaly: Comparison with T2 and FLAIR Imaging 원문보기

대한자기공명의과학회지 = Journal of the Korean society of magnetic resonance in medicine, v.18 no.3, 2014년, pp.200 - 207

초록
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목적: 뇌정맥 기형의 발견에 있어 자화율강조 MR영상의 진단적 가치를 평가하고자 하였다. 대상과 방법: 1068명의 뇌MR영상의 후향적 분석에서 조영증강 T1강조영상을 기준으로 28명(2.6%)에서 28개의 뇌정맥 기형이 발견 되었다. 이들과 성별 및 나이가 일치하는 뇌정맥 기형이 없었던 28명을 대조군으로 선정하였다. 모두 48명의 환자군과 대조군의 MR영상을 무작위로 제시하면서 2명의 영상의학과 의사가 독립적으로 분석하였다. 자화율강조영상, T2강조영상, FLAIR영상을 분리하여 각 영상에서 뇌정맥 기형의 존재유무를 판정하였다. 판정에 불일치가 있는 경우 나중에 합의하여 최종 판단하였다. 뇌정맥 기형의 진단에 있어 각 영상의 민감도, 특이도, 양성예견율, 음성예견율을 구하였으며, Mcnemar test를 이용하여 통계적 차이를 검정하였다. 결과: 뇌정맥 기형의 발견에 있어 자화율강조 MR영상은 85.7%의 민감도, 92.9%의 특이도, 92.3%의 양성예견율, 86.7%의 음성예견율을 보였다. T2강조영상과 FLAIR영상은 35.7% 와 35.7%의 민감도, 92.9%와 96.4%의 특이도, 83.3%와 90.9%의 양성예견율, 59.1%와 60.0%의 음성예견율을 각각 보였다. 통계분석에서 자화율강조 MR영상은 T2강조영상과 FLAIR영상과 비교하여 유의하게 높은 민감도와 음성예견율를 보였다. 결론: 뇌정맥 기형의 발견에 있어 자화율강조 MR영상은 높은 민감도와 특이도를 보였다.

Abstract ▼ AI-Helper

Purpose : We evaluated the diagnostic value of susceptibility-weighted imaging (SWI) for the detection of developmental venous anomaly (DVA). Materials and Methods: Retrospective review of 1068 brain MR examinations found 28 DVAs in 28 patients (2.6%) on contrast-enhanced T1-weighted images. SWI, T2, and FLAIR images of 28 patients with DVA and 28 sex- and age-matched control patients without DVA were analyzed by blinded readers on each type of sequences. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. In cases of discrepancy, two reviewers reached a consensus later. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each MR sequence for the detection of DVA were determined. Statistical analysis was performed by using the Mcnemar test. The significance level was p < 0.05. Results: The sensitivity, specificity, PPV, and NPV of SWI for the detection of DVA were 85.7%, 92.9%, 92.3%, and 86.7%, respectively. T2 and FLAIR images showed sensitivity of 35.7% and 35.7%, specificity of 92.9% and 96.4%, PPV of 83.3% and 90.9%, and NPV of 59.1% and 60.0%, respectively. On SWI, the sensitivity and NPV for the detection of DVAs were significantly higher than those of T2 and FLAIR images (p < 0.05). Conclusion: SWI was sensitive and specific for the detection of DVA.

Keyword

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가설 설정

Enhanced T1-weighted image (a) and SWI (b) show a DVA in the right frontal lobe (arrow). On T2 (c) and FLAIR (d) images, there is no definite abnormality in the right frontal lobe.

제안 방법

The goal of this study was to evaluate the diagnostic value of SWI compared with T2-weighted and FLAIR images for the detection of DVA.
SWI, T2, and FLAIR images of the patients and control groups were analyzed by blinded readers on each type of sequences. All images were reviewed independently by two radiologists who were blinded to other MR imaging. In cases of discrepancy, two reviewers reached a consensus later.

대상 데이터

All MR examinations were performed at a 1.5 Tesla MR scanner (Magnetom Avanto, Siemens Medical solutions, Erlangen, Germany). MR protocol consisted of T2-weighted imaging, fluid-attenuated inversion recovery (FLAIR), T1-weighted imaging, SWI, and CE T1-weighted imaging, respectively (Table 1).
In the initial assessment for the detection of DVA, each reader showed the same result in 51 patients for T2, 48 for FLAIR, and 47 for SWI, respectively. Interobserver agreement rate between each reader was 91.
3. A 77-years-old female patient with mixed angioma (DVA and cavernous angioma). Enhanced T1 (a), T2 (b), FLAIR (c), and SWI (d) images show a hemorrhagic lesion with heterogeneous signal intensity (suggestive of cavernous angioma) in the right parietal lobe (arrow).
4. A 61-years-old female patient with parenchymal hemorrhage. SWI (a) shows a tubular signal void lesion in the right frontal lobe (arrow).

데이터처리

The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each MR sequence for the detection of DVA were determined. Statistical analysis was performed by using the Mcnemar test. The significance level was p < 0.

성능/효과

The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each MR sequence for the detection of DVA were determined.
The sensitivity, specificity, PPV, and NPV of SWI for the detection of DVA were 85.7%, 92.9%, 92.3%, and 86.7%, respectively. T2 and FLAIR images showed sensitivity of 35.
7%, respectively. T2 and FLAIR images showed sensitivity of 35.7% and 35.7%, specificity of 92.9% and 96.4%, PPV of 83.3% and 90.9%, NPV of 59.1% and 60.0%, respectively. On SWI, sensitivity and NPV for the detection of DVAs were significantly higher than those of T2 and FLAIR images (p < 0.
In conclusion, SWI was sensitive and specific for the detection of DVA.

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