복부 Dynamic MRI검사 시 조영제 주입 속도에 대한 고찰 : 이상 반응 발생 빈도와 신호 대 잡음비 분석을 중심으로

서지정보

ㆍ발행기관 : 대한자기공명기술학회 ㆍ수록지정보 : 대한자기공명기술학회지 / 25권
ㆍ저자명 : 박형민, 성호진, 위성문, 김미정, 범희남

목차

Ⅰ.서 론
Ⅱ. 대상 및 방법
1. 대상
2. 장비 및 검사 방법
3. 분석 방법
Ⅲ. 결 과
Ⅳ.결론 및 고찰
Ⅴ. Reference

한국어 초록

목 적 : 복부 dynamic검사 시 조영제 주입 후 환자의 이상 반응 발생 빈도 및 조영제의 신호 대 잡음비 분석을 통해 적정한 조영제 주입 속도를 알아보고자 하였다.
대상 및 방법 : 2013년 4월부터 2014년 9월까지 3.0T MRI system(Magnetom Tim Trio, Siemens, Germany)을 이용하여 Gadoxetic acid(Primovist, Bayer Schering Pharma)를 사용한 309명(남자 223명, 여자 86명)을 대상으로 Liver dynamic검사를 하였고, Gadodiamide(Ominisacn, GE healthcare)을 사용한 247명(남자 148명, 여자 99명)을 대상으로 Cholangio, Pancreas MRI 상복부 검사를 시행하였다. Saline은 주입 속도를 조영제와 동일하게 주입했으며 그 양은 30ml로 고정하고 gadoxetic acid의 양은 0.1ml/kg, 조영제의 주입속도는 1.0cc/sec, 1.5cc/sec, 2.0cc/sec로 60sec, 100sec을 측정했다. Gadodiamide의 양은 0.2ml/kg, 조영제 주입 속도는 1.5cc/sec, 2.0cc/sec, 2.5cc/sec로 60sec, 120sec을 측정했으며 Volumetric Interpolated Breath-hold Examination(VIBE) sequence를 적용하여 영상을 획득하였다. 상복부 MRI검사 시 조영제의 주입속도에 따른 이상 반응 유무 및 발생 빈도를 분석하고 획득한 영상은 PACS viewer에서 각 phase 별로 ROI를 5~15mm로 main portal vein, liver parenchyma, aorta를 세 곳 설정하여 각 부위의 SNR을 60초, 100초, 120초 검사 중심으로 정량 분석하였다.
결 과 : Liver MRI의 arterial phase 시간대 이상 반응(일시적 호흡곤란, 기침, 구토, 가슴 답답함 등) 발생 빈도는 2.0cc/sec는 98명 중 23건(23.5%), 1.5cc/sec는 116명 중 44건(37.9%), 1.0cc/sec에서 95명 중 22건(23.2%)으로 나타났다. SNR은 조영제주입 속도를 2.0cc/sec로 했을 때 60초 검사에서 portal vein 439.13±38.26, liver parenchyma 250.54±28.54, aorta 311.74±33.24였고 100초에서는 312.01±20.29, 283.88±28.60, 250.38±22.68이었다. 1.5cc/sec의 경우 60초 검사에서 portal vein 415.81±42.43, parenchyma 247.14±28.24, aorta 305.48±30.16, 100초엔 각각 339.20±32.12, 273.65±29.28, 264.66±29.84였다. 1.0cc/sec의 경우 60초 검사는 portal vein 400.44±42.43, parenchyma 237.95±28.30, aorta 307.24±33.69, 100초는 359.17±31.67, 259.13±27.90, 280.49±32.74였다.
Cholangio MRI는 2.5cc/sec는 90명 중 6명(6.7%), 2.0cc/sec는 87명 중 3명(3.4%), 1.5cc/sec에서 70명 중 4명(5.7%)이 arterial phase에서 이상 반응이 발생됐다. 신호대 잡음비는 2.5cc/sec로 조영제 주입 시 60초 검사에서 portal vein 659.09±59.10, liver parenchyma 367.40±39.09, aorta 537.40±41.82였으며 120초에서 각각 546.79±40.35, 376.15±28.79, 470.59±36.99였다. 2.0cc/sec로 주입했을 땐 60초에 portal vein 648.18±61.19, parenchyma 360.49±41.35, aorta 540.07±51.77이었고 120초는 각각 559.26±52.35, 343.70±38.27, 474.57±42.02였으며 1.5cc/sec로 주입 시엔 60초에 portal vein 637.62±54.24, parenchyma 358.85±42.87, aorta 544.25±47.16였고 120초는 562.35±39.57, 303.91±40.20, 481.22±40.14이었다.
결 론 : 조영제의 주입 속도를 2.0cc/sec로 했을 경우 Liver MRI는 저속 주입 시 보다 60초와 100초 검사에서 이상 반응의 증가없이 SNR이 더 좋은 영상을 획득했다. Cholangio MRI 또한 60초와 120초 검사에서 2.5cc/sec로 주입했을 때 저속 주입 시 보다 SNR이 더 우수한 영상을 얻을 수 있었다.

영어 초록

Purpose : The purpose of this study is to evaluate the proper contrast injection rate for abdominal dynamic MRI through the side effect and signal intensity analysis.
Materials and Methods : Three hundred nine patients( 223 men; 86 women) which used Gadoxetic acid(Primovist, Bayer Schering Pharma) and twenty hundred fourty seven (148 men; 99 women) which used Gadodiamide(Ominisacn, GE healthcare) were examined on 3.0T MRI(Magnetom Tim Trio, Siemens, Germany) from April 2013 to september 2014. Injection amount of Saline (same contrast injection rate) was fixed to 30ml and the amount Primovist 0.1ml/kg. The injection rate of the Primovist was 1.0cc/sec, 1.5cc/sec, 2.0cc/sec and we measured 60sec and 100sec. Omniscan was amount 0.2ml/1kg that injection rate was 1.0cc/sec, 2.0cc/sec, 2.5cc/sec We was measured 60sec and 120sec. Images were obtained by the Volumetric Interpolated Breath-hold Examination(VIBE) sequence. We analyzed the presence and incidence of side effect in accordance with the contrast flow rate of abdominal MRI. The acquired image through ROI(5~15mm) of the main portal vein, liver parenchyma and aorta in each phase was set up three places from the PACS viewer. Signal intensity of each region is quantitatively analyzed in 60, 100 and 120sec.
Results : The incidence of side effect(temporary shortness of breath, cough, vomiting, chest tightness, etc.) of arterial phase time was 22case of 95 people at 1.0cc/sec, 44case of 116 people at 1.5cc/sec and 23case of 98 people at 2.0cc/sec in Liver MRI. When the contrast injection rate to 2.0cc/sec, the SNR of 60sec scan was portal vein 439.13±38.26, liver parenchyma 250.54±28.54 and aorta 311.74±33.24. That was 312.01±20.29, 283.88±28.60, 250.38±22.68 in the 100sec scan. When the contrast injection rate to 1.5cc/sec, the SNR of 60sec scan was portal vein 415.81±42.43, liver parenchyma 247.14±28.24 and aorta 305.48±30.16. That was 339.20±32.12, 273.65±29.28, 284.66±29.84 in the 100sec scan. When the contrast injection rate to 1.0cc/sec, the SNR of 60sec scan was portal vein 400.44±42.43, liver parenchyma 237.95±28.30 and aorta 307.24±33.69. That was 359.17±31.67, 259.13±27.90, 280.49±32.74 in the 100sec scan. The incidence of side effect of arterial phase time was 6case(6.7%) of 90 people at 2.5cc/sec, 3case(3.4%) of 87people at 2.0cc/sec and 4case(5.7%) of 70 people at 1.5cc/sec in Cholangio MRI. When the contrast injection rate to 2.5cc/sec, the SNR of 60sec scan was portal vein 659.09±59.10, liver parenchyma 367.40±39.09 and aorta 537.40±41.82. That was 546.79±40.35, 376.15±28.79, 470.59±36.99 in the 120sec scan. When the contrast injection rate to 2.0cc/sec, the SNR of 60sec scan was portal vein 648.18±61.19, liver parenchyma 360.49±41.35, and aorta 540.07±51.77. That was 559.26±52.35, 343.70±38.27, 474.57±42.02 in the 120sec. When the contrast injection rate to 1.5cc/sec, the SNR of 60sec scan was portal vein 637.62±54.24, liver parenchyma 358.85±42.87, and aorta 544.25±47.16. That was 562.35±39.57, 303.91±40.20, 481.22±40.14 in the 120sec scan.
Conclusion : When the injection rate of the contrast agent to 2.0cc/sec, Liver MRI was no difference in the incidence of side effects as well as other velocities. But, The high signal intensity of image was obtained at 60sec and 100sec. Also, Cholangio MRI was no difference in the incidence of side effects. When injected into the 2.5cc/sec, We could be obtained an image with a higher signal than in the slow injection. Increasing the contrast injection rate, it is easier to distinguish between organizations and the time difference becomes more apparent in the abdominal dynamic MRI.

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