내경동맥의 협착 및 폐색의 평가에 있어서의 비침습적인 영상의학적 검사방법들의 비교 연구 : CT혈관조영술(CTA), 유체속도강도 자기공명혈관조영술(TOF-MRA), 조영증강 자기공명혈관조영술(CE-MRA)
Comparison of Non-invasive Imaging Studies in the Evaluation of Carotid Artery Stenosis and Occlusion: CT Angiography, Time-of-Flight MR Angiography and Contrast-Enhanced MR Angiography
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목적: 내경동맥의 협착 및 폐색의 진단에 대해 CT혈관조영술(이하CTA), 유체속도강조 자기공명혈관조영술(이하 TOF-MRA), 조영증강 자기공명혈관조영술(이하 CE-MRA)을 비교하였다. 대상과 방법: 내경동맥의 협착 및 폐색질환이 의심되는 증상이 있거나, 건강검진상 시행한 색도플러초음파상 내경동맥의 협착이 50%이상 의심되는 환자 총 20명을 대상으로 시행하였다. 전향적으로 CTA, TOF-MRA, CE-MRA 를 함께 시행하였으며, CTA를 표준지표로 하여 세 검사간의 상관관계 및 민감도, 특이도, 양성 예측도, 음성 예측도, 정확도를 측정하였다. 결과: 세 검사의 협착도 간의 유의한 차이는 없었다(p > 0.05). CTA와 TOF-MRA간의 상관계수는 0.932, CE-MRA와의 상관계수는 0.971로 나타났다. 50% 이상의 협착 및 폐색에 대한 TOF-MRA의 민감도, 특이도, 양성예측도, 음성예측도, 정확도는 83.3%, 87.5%, 71.4%, 93.3%, 86.4% 였으며, CE MRA는 83.3%, 93.8%, 83.3%, 93.8%, 90.9%로 나타났다. 결론: 내경동맥의 협착의 평가에서 TOF-MRA와 CE-MRA는 CTA와 높은 상관관계를 보였다.
Abstract
Purpose : We compared non-invasive imaging studies of CTA, TOF-MRA and CE-MRA to evaluate detecting internal carotid artery stenosis and occlusion. Materials and Methods : We enrolled 20 patients with clinically suspected internal carotid artery stenosis and occlusion, or asymptomatic patient with more than 50% stenosis suspected on color Doppler ultrasonography for regular check-up. Prospectively, CTA, TOF-MRA and CE-MRA were performed, and sensitivity,specificity, positive predictive value, negative predictive value and accuracy of TOF-MRA and CEMRA using CTA as a reference standard for detecting more than 50% stenosis were evaluated, and correlations of measured percent stenosis between 3 imaging studies were also evaluated. Results : No significant difference was found between 3 imaging studies in measuring stenosis(p>0.05). Correlation coefficient was 0.932 between CTA and TOF-MRA, and 0.971 between CTA and CE-MRA. TOF-MRA had 83.3% sensitivity, 87.5% specificity, 71.4% positive predictive value, 93.3% negative predictive value and 86.4% accuracy for detecting more than 50% stenosis and occlusion. CE-MRA had 83.3% sensitivity, 93.8% specificity, 83.3% positive predictive value, 93.8% negative predictive value and 90.9% accuracy. Conclusion : TOF-MRA and CE-MRA provided high correlations in the evaluation of internal carotid artery stenosis and occlusion.
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