급성 폐혈전색전증의 중증도 평가에 있어 이중 에너지 전산화단층촬영의 진단적 유용성에 관한 연구 = Diagnostic Usefulness of Dual-Energy Computed Tomography in Evaluation of the Severity of Acute Pulmonary Thromboembolism

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the usefulness of dual-energy computed tomography (DECT) in severity assessment of patients with acute pulmonary thromboembolism (APTE).
Materials and Methods: We evaluated 61 patients diagnosed as APTE from 2011 to 2012 in a retrospective analysis of the severity assessment indices according to Criteria by European Society of Cardiology as well as pulmonary CT angiographic obstruction score (OS) and lung perfusion index (pulmonary perfusion defect score; DS) by DECT. The correlation between OS, DS and the severity of pulmonary thromboembolism was evaluated using logit analysis.
Results: Patients with high OS also showed significantly higher DS values (p < 0.001). There was a significant correlation between both the OS and DS values and the severity of the pulmonary thromboembolism using simple sequence logit analysis (p < 0.001). However, only the DS value showed a very high correlation with the severity of pulmonary thromboembolism using multiple sequence logit analysis.
Conclusion: DECT provides a more useful marker for the diagnosis and severity assessment of pulmonary thromboembolism by checking the degree of lung perfusion as well as determining the existence of APTE in patients with suspected pulmonary thromboembolism.

국문 초록 (Abstract)

목적: 급성 폐혈전색전증 환자의 중증도 평가에 있어 이중 에너지 전산화단층촬영(dual-energy computed tomography; 이 하 DECT)의 유용성에 대해 알아보고자 했다.
대상과 방법: 2011년부터 2012년까지 급성 폐혈전색전증으로 진단된 61명의 환자를 대상으로 후향적 분석을 했다. 대상 환자의 중증도 평가와 함께 DECT를 이용해 폐동맥 혈전색전지수(pulmonary CT angiographic obstruction score; 이하 OS)와 폐 관류결손지수(pulmonary perfusion defect score; 이하 DS) 정도를 평가했고 서열 로짓 분석을 통해 OS, DS, 그리고 폐혈전색전증의 중증도 간의 상관 관계를 분석했다.
결과: 높은 OS를 가진 폐혈전색전증 환자는 DS도 높은 값을 보였다(p ＜ 0.001). 단순 서열 로짓 분석 때는 OS와 DS 모두 폐혈전색전증의 중증도와 높은 상관 관계(p ＜ 0.001)를 보였지만 다중 서열 로짓 분석 이후에는 DS만이 폐혈전색전증의 중증도와 매우 높은 상관 관계를 보였다.
결론: 폐혈전색전증이 의심되는 환자에서 DECT는 급성 폐혈전색전증 유무를 확인하는 동시에 폐 실질의 관류 정도를 확인하여 폐혈전색전증의 진단뿐 아니라 중증도 평가에 더 유용한 지표를 제공하는 것으로 사료된다.

참고문헌 (Reference)

1 Seon HJ, "Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Comparison with cardiac biomarkers" 75 : 428-436, 2011

2 Nikolaou K, "Pulmonary arterial hypertension:diagnosis with fast perfusion MR imaging and highspatial-resolution MR angiography--preliminary experience" 236 : 694-703, 2005

3 Petersson J, "Physiological imaging of the lung: single-photon-emission computed tomography (SPECT)" 102 : 468-476, 2007

4 Ryan KL, "Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension" 93 : 1180-1185, 1988

5 Qanadli SD, "New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography" 176 : 1415-1420, 2001

6 Johnson TR, "Material differentiation by dual energy CT: initial experience" 17 : 1510-1517, 2007

7 Kasper W, "Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry" 30 : 1165-1171, 1997

8 Fink C, "MRI of pulmonary embolism" 47 : 708-715, 2007

9 Torbicki A, "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)" 29 : 2276-2315, 2008

10 Flohr TG, "First performance evaluation of a dual-source CT (DSCT) system" 16 : 256-268, 2006

11 Thieme SF, "Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma" 193 : 144-149, 2009

12 Chae EJ, "Dual-energy CT for assessment of the severity of acute pulmonary embolism: pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio" 194 : 604-610, 2010

13 Hoey ET, "Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience" 196 : 524-532, 2011

14 Kreitner KF, "Chronic thromboembolic pulmonary hypertensionassessment by magnetic resonance imaging" 17 : 11-21, 2007

15 Chung MJ, "CT perfusion image of the lung: value in the detection of pulmonary embolism in a porcine model" 39 : 633-640, 2004

16 Dogan H, "Assessment of right ventricular function in acute pulmonary embolism using ECG-synchronized MDCT" 195 : 909-915, 2010

17 Ley S, "Assessment of pulmonary hypertension by CT and MR imaging" 14 : 359-368, 2004

18 Wildberger JE, "Approaches to CT perfusion imaging in pulmonary embolism" 40 : 64-73, 2005

19 Anderson FA Jr, "A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study" 151 : 933-938, 1991