심장 아밀로이드증의 지연 조영증강 MR 영상소견
Delayed Enhancement Magnetic Resonance Imaging Findings in Cardiac Amyloidosis
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목적 : 심장 아밀로이드증 환자의 심장 자기공명영상의 지연 조영증강영상에서 좌심근의 조영증강 패턴과 다른 심장부위의조영증강 유무를 평가하고자 하였다. 대상 및 방법 : 2009년 9월부터 2011년 6월 사이 심장 아밀로이드증이 의심되어 심장 자기공명영상을 촬영한 9명의 환자를 후향적으로 분석하였다. 좌심근의 조영증강 여부 및 패턴, 그리고 좌우심방 및 우심실의 조영증강 유무를 평가하였다. 또한 심방중격 두께, 좌심방 혈액신호 강도에 대한 심방중격과 심외막 지방의 상대적 신호강도 비를 계산하여 허혈성 심질환 대조군 16명과 Wilcoxon rank sum test를 통해 통계적으로 비교분석 하였다. 결과 : 총 9명중 8명에서 좌심근 조영증강소견을 보였으며, 8명중 4명의 환자에서 심내막하 원형성, 나머지 4명에서 미만성패턴을 보였다. 심방중격 두께는 심장 아밀로이드증 환자에서 허혈성 심질환 환자에 비해서 증가되어 있었고 (p = 0.02),심장 아밀로이드증 환자군에서 심방중격 대 혈액 신호 강도비 (p = 0.0002) 및 심외막 지방 대 혈액 신호 강도비 (p =0.0006) 모두 의미있게 높았다. 결론 : 좌심실의 심내막하 원형성 혹은 미만성 조영증강 패턴은 심장 아밀로이드증 환자의 지연 조영 심장 자기공명영상의 특징적인 소견이며, 심방중격 및 심외막 지방 대 혈액 신호 강도비 신호강도가 상대적으로 증가된다.
Abstract
Purpose : To evaluate late gadolinium enhancement (LGE) pattern of left ventricular (LV) myocardium and presence or absence of LGE in other regions of the heart on cardiac magnetic resonance (CMR) imaging in patients diagnosed with cardiac amyloidosis. Materials and Methods: From 2009 to 2011, 9 patients who were suspected cardiac amyloidosis underwent CMR. We retrospectively analyzed the presence or absence of LGE and enhancement pattern in LV myocardium, and the presence or absence of LGE in other chambers as well. Also we measured interatrial septal thickness (IST), relative signal intensities of atrial septum and epicardial fat over the left atrial (LA) cavity on delayed enhanced images. MRI parameters in these patients were compared to those of control group of patients with ischemic heart disease by Wilcoxon rank sum test. Results: Of nine patients, LGE were found in 8; subendocardial circumferential pattern in 4 and diffuse pattern in 4. LGE in right ventricle was observed in 7. IST was significantly increased in patients with cardiac amyloidosis (P = 0.02). Ratio of atrial septum to LA cavity and ratio of epicardial fat to LA cavity showed a significant difference (P = 0.0002 and P = 0.0006, respectively). Conclusion: In LGE CMR, subendocardial or diffuse enhancement pattern is a typical finding for patients with cardiac amyloidosis. Atrial septum and epicardial fat show relatively increased signal intensities over LA blood cavity.
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