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3 Table 2. Comparison of Detection of Stenosis Lesion of 344 Vascular Segments in 43 Patients between 3 Tesla Time-of-Flight MR Angiogram and Results of Transcranial Doppler Sonography % Stenosis at TCD % Stenosis at MRA Normal Mild Severe Total (0 15) (16 50) (51 100) Normal (0 15) Mild (16 50) Severe Table 1. Averaging Grading Score for Assessment of Vascular (51 100) Imaging Quality on 3 Tesla Time-of-Flight MR Angiogram Total Reader A Reader B Mean Group I Group II Group III Group IV Group I :Scanned segment of vertebral arteries and basilar artery Group II :Segment between 2 cm below bifurcation of common carotid artery and genu portion of internal carotid artery Group III :Segment between petrous portion of internal carotid artery and bifurcation of anterior and middle cerebral arteries Group IV :From bifurcation of anterior and middle cerebral artery to thier distal branches Scoring system 1: Poor quality information; non-diagnostic 2: Anatomy visible with moderate blurring; able to establish to diagnosis 3: Sharply defined borders; excellent quality diagnostic information 3T-TOF MRA: 3 Tesla time-of-flight magnetic resonance angiography TCD: transcranial doppler sonography 3T-TOF MRA: 3 Tesla time-of-flight magnetic resonance angiography *In three segments, the results of TCD is normal, but stenosis is noted on 3T-TOF MRA Table 3. Comparison of Detection of Stenotic Lesion on 88 Vascular Segments of 11 Patients among Conventional Angiography, 3 Tesla Time-of-Flight MR Angiogram and Results of Transcranial Doppler Sonography CA 3T-TOF MRA TCD Normal (0 15%) Mild (16 50%) Stenosis (51 100%) Total CA: conventional angiography TCD: transcranial doppler sonography 3T-TOF MRA: 3 Tesla time-of-flight magnetic resonance angiography

4 뇌졸중 환자에서 3 Tesla 자기공명혈관조영술의 유용성 째로 혈관과 배후조직사이의 대조도가 혈류속도에 의해 좌우되 어 대조도 대 잡음비와 병적상태에서 느린 혈류속도를 보이는 혈관의 조영에 영향을 주게 된다. 최근 임상에 이용되기 시작한 3T의 고자장 자기공명영상기 는 여러 가지 장점이 있다 (16-18). 그 중 하나는 자장의 세 기에 선형으로 비례하는 신호 대 잡음비의 향상이다. 일부 팬 톰연구에서 1.5T 장비보다 2배 이상의 신호 대 잡음비가 증가 하는 것으로 보고 되고 있다. 이러한 장점은 곧바로 MRA에 큰 영향을 끼치는데 고해상의 영상을 얻을 수 있고 짧은 시간 내 에 스캔을 할 수 있다는 것이다. 본 연구의 경우도 TCD와 CA a b Fig. 1. High grade stenosis of M1 portion of right middle cerebral artery is seen on 3T- TOF-MR angiogram, transcranial Doppler sonograph, and conventional angiogram in a 47-year-old-woman. Anteroposterior view of reprojection 3T-TOF-MR angiogram (a) and anteroposterior view of conventional angiogram (b) show severe stenosis of M1 portion of right middle cerebral artery, and increased mean flow velocity in the right middle cerebral artery in transcranial Doppler sonograph (c). c Fig. 2. High grade stenosis of left internal carotid artery is depicted on 3T-TOF-MR angiogram, TCD, and conventional angiogram in a 68-year-old-man. Anteroposterior oblique view of reprojection 3TTOF-MR angiogram (a), and lateral view of conventional angiogram (b) show severe stenosis of left internal carotid artery and increased mean flow velocity in the left internal carotid artery on transcranial Doppler sonograph (c). a b c

5 한제희 외 b a Fig. 3. Multifocal stenosis of basilar artery is noted on 3T-TOF-MR angiogram, transcra- nial Doppler sonograph, and conventional angiogram in a 65-year-old-man. Anteroposterior views of reprojection 3T-TOF-MR angiogram (a) and anteroposterior view of conventional angiogram (b) show diffuse stenosis of basilar artery and high flow velocity in the basilar artery on transcranial Doppler sonograph (c). c 를 모두 시행한 11명에서는 3T-TOF MRA가 TCD 및 CA와 모두 일치하였는데 이는 CA와 비슷한 혈관영상을 얻을 수 있 다는 것을 알 수 있었다. 또한 스캔하여 얻는 시간도 1.5T에 비해 비교적 단축되었음을 알 수 있었다. 3 Teslar MRA는 기 존 1.5 Teslar MRA에 비해 보다 더 신속하게, 말단부위 혈관 까지도 잘 볼 수 있는 정확한 혈관 조영 기법으로, 뇌졸중이 의 심되는 환자의 선별검사 및 진단검사로써 앞으로의 이용도는 더 욱 증가할 것으로 사료된다. 3T에서 시행하는 TOF 기법은 1.5T장비보다 몇 가지 장점 이 있다 (16, 17). 3T에서는 T1이완시간이 길어지는데 정상 뇌 조직은 25-40%정도 증가되나 혈액은 이완시간이 비교적 짧기 때문에 큰 영향을 받지 않아 배후 조직영상을 억제하기 때 문에 대조도가 좋은 혈관조영상을 얻을 수 있다. 또한 3T에서 는 1.5T에 비해 in-plane blood saturation 에 대한 영향이 같 은 슬랩두께라면 비슷하기 때문에 좀더 완전하게 포화된 혈액 이 영상단면으로 들어오기 때문에 혈관영상이 더 좋아지게 된 다. 또한 플립앵글 (flip angle)도 더 줄일 수 있기 때문에 배후 잡상을 더 줄일 수 있는 조건이 되어 좋은 혈관영상을 얻을 수 있다. 따라서 1.5T에 비해 전,중,후 대뇌동맥의 이 세대 이상의 작은 가지도 잘 볼 수 있게 되었다. 본 연구에서도 작은 가지 인 IV군에서 양호한 등급의 점수를 얻어 작은 가지도 잘 볼 수 있었다. TCD는 비침습적이고, 쉽고, 저비용이어, 반복검사를 할 수 있다는 점에서 두개내 혈관상태를 파악하는데 기본이 되고 있 다. TCD는 동맥의 혈류역학상태를 잘 나타 내기 때문에 뇌동 맥류 파열환자에서 혈관 연축이나 뇌경색환자에서 혈관의 폐색 혹은 협착정도를 잘 나타내는 의의 있는 검사로 평가받고 있다. 그렇지만, 협착의 정도가 심하지 않을 경우 혈류역동학적인 변 화를 잘 초래 하지 않으므로 TCD로 이를 찾아내기에 어려운 단점이 있다 (10). 본 연구에서도 TCD 만을 시행한 43명중, 2 명의 판독자 모두 41명에서 3T-TOF MRA와 TCD의 판독소 견이 일치 하였는데, 3T-TOF MRA에서 14명의 환자에서 모 두 22 혈관분절이 협착에 의한 소견을 보이고 있었지만, TCD 에서는 12명의 환자에서 모두 19 혈관분절에서 협착의 소견이 보였다. 결 론 뇌혈관 평가에 있어서 TCD와 CA와 비교하여 3T-TOF MRA의 유용성에 대해 알아보고자 하여 다음과 같은 결과를 얻 었다 정성평가에서 I, II, III, IV군은 각각 2.98, 2.96, 2.91, 2.88로 혈관의 양상에 대한 파악은 잘 되는 것으로 나타

6 2002;23: Chung TS, Joo JY, Lee SK, et al. Evaluation of cerebral a- neurysms with high-resolution MR angiography using a section-interpolation technique: correlation with digital subtrac- tion angiography. AJNR Am J Neuroradiol 1999;20: White PM, Wardlaw JM, Easton V. Can non-invasive imaging accurately depict intracranial aneurysms? a systemic review. Radiology 2000;217: Lysakowski C, Walder B, Costanza MC, Tramr MR. Transcranial doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm. Stroke 2001;32: Yang JJ, Hill MD, Morrish WF, et al. Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusion in acute ischemic 1.,,,,,.. stroke. AJNR Am J Neuroradiol 2002;23: ;34: van Heesewijk HPM, Vos JA, Louwerse ES, et al. New brain 2.,,. lesions at MR imaging after carotid angiography and stent. 1994;31:607- placement. Radiology 2002;224: Nederkoorn PJ, Elgersma OEH, van der Graaf Y, Eikelboom 3.,,. Enhanced 3D-TOF BC, Kappelle LJ, Mali WPTM. Carotid artery stenosis: accuracy of contrast enhanced MR angiography for diagnosis. :. 2000;42: Radiology 2003; 228: Elgersma OEH, Wust AFJ, Buijs PC, et al. Multidirectional depiction of internal carotid arterial stenosis : three - dimensional angiography of the carotid artery: comparison with conven- 14.Remonda L, Senn P, Barth A, et al. Contrast-enhanced 3D MR time-of-flight MR angiography versus rotational and conventional digital subtraction angiography. Radiology 2002;23: tional digital subtrtion angiography. AJNR Am J Neuroradiol 2000;216: Hustoan III J, Fain SB, Wald JT, et al. Carotid artery: elliptic 5.Gillard JH, Oliverio PJ, Barker PB, Oppenheimer SM, Bryan centric contrast-enhanced MR angiography compared with RN. MR angiography in acute cerebral ischemia of the anterior conventional angiography. Radiology 2001;218: circulation: a preliminary report. AJNR Am J Neuroradiol 16.Compeau NG, Huston III J, Bernstein MA, et al. Magnetic resonance angiography at 3.0 Tesla: initial clinical experience. 1997;18: Randoux B, Marro B, Koskas F, et al. Carotid artery stenosis: Topics in Magnetic Resonance Imaging, 2001;12: prospective comparison of CT, three-dimensional gadoliniumenhanced MR, and conventional angiography. Radiology Tesla in time-of-flight magnetic resonance angiography of the 17.Al-Kwifi O, Emery DJ, Wilman AH. Vessel contrast at three 2001;220: intracranial and carotid arteries. J Magn Reson Imaging 7.Hirai T, Korogi Y, Ono K, et al. Prospective evaluation of suspected stenoocclusive disease of the intracranial artery: com- 18.Frayne R, Goodyear BG, Dickhoff P, et al. Magnetic resonance 2002;20: bined MR angiography and CT angiography compared with imaging at 3.0 Tesla: challenges and advantages in clinical neurological imaging. Invest Radiol 2003;38: digital subtraction angiography. AJNR Am J Neuroradiol

7 The Usefulness of 3T-TOF MR angiography in Patients with Cerebral Infarction Je hee Han, Jeong Jin Seo, Tae Woong Chung, Woong Yoon, Nan Kyu Jang, Sang Soo Shin, Hyo Soon Lim, Sang Gook Song, Yong Yeon Jeong, Heoung Keun Kang 1 Department of Diagnostic Radiology, Chonnam National University Medical School Purpose : This study was designed to evaluate the usefulness of 3T-TOF MR angiography (3T-TOF MRA) compared with transcranial Doppler sonography (TCD) and conventional angiography (CA) in patients with suspected cerebral infarction. Materials and Methods : Fifty four patients with clinical symptoms of cerebral infarction were involved in this study, and had undergone 3T-TOF MRA and TCD, with CA in 11 patients. On the basis of divisions of the carotid artery, four groups were designated: group I, both vertebral arteries and basilar artery; group II, segment between 2 cm below bifurcation of common carotid artery and genu portion of internal carotid artery; group III, segment between petrous portion of internal carotid artery and bifurcation of anterior and middle cerebral artery; group IV, from bifurcation of anterior and middle cerebral artery to thier distal branches. Two radiologists retrospectively reviewed the vascular imaging and stenosis in 3T-TOF MRA, TCD, and CA. Results : A total of 432 arteries, 108 in each group, were available. The assessment of vascular imaging quality in 3T-TOF MRA is scored 2.98, 2.96, 2.91, 2.88 in 4 groups, respectively. Agreement among 3T- TOF MR angiography, TCD, and CA was high. Conclusion : 3T-TOF MR angiography may be useful method for the assessment of stenotic lesions of cranial vasculature in patients with cerebral infarction. Index words : Brain, MR Magnetic resonance (MR), vascular studies Cerebral blood vessels, disease Address reprint requests to : Jeong Jin Seo, M.D, Department of Diagnostic Radiology, Chonnam National University Medical School, 8 Hack-Dong, Dong-Ku, Gwang-Ju , Korea. Tel Fax

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