급성기 뇌지주막하출혈에서 Three-Dimensional Computed Tomographic Angiography (3-D CTA)의 유용성

임동준,이훈갑,김봉룡,정흥섭,정용구,이기찬,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve in Patients with Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus

Chun Xiang Tang,Meng Jie Lu,Joseph Uwe Schoepf,Christian Tesche,Maximilian Bauer,John Nance,Parkwood Griffith,Guang Ming Lu,Long Jiang Zhang 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.2

Objective: To examine the fractional flow reserve derived from computed tomographic angiography (CT-FFR) in patients with anomalous origin of the right coronary artery from the left coronary sinus (R-ACAOS) with an interarterial course, assess the relationship of CT-FFR with the anatomical features of interarterial R-ACAOS on coronary computed tomographic angiography (CCTA), and determine its clinical relevance. Materials and Methods: Ninety-four patients with interarterial R-ACAOS undergoing CCTA were retrospectively included. Anatomic features (proximal vessel morphology [oval or slit-like], take-off angle, take-off level [below or above the pulmonary valve], take-off type, intramural course, % proximal narrowing area, length of narrowing, minimum luminal area [MLA] at systole and diastole, and vessel compression index) on CCTA associated with CT-FFR ≤ 0.80 were analyzed. Receiver operating characteristic analysis was performed to describe the diagnostic performance of CT-FFR ≤ 0.80 in detecting interarterial R-ACAOS. Results: Significant differences were found in proximal vessel morphology, take-off level, intramural course, % proximal narrowing area, and MLA at diastole (all p < 0.05) between the normal and abnormal CT-FFR groups. Take-off level, intramural course, and slit-like ostium (all p < 0.05) predicted hemodynamic abnormality (CT-FFR ≤ 0.80) with accuracies of 0.69, 0.71, and 0.81, respectively. Patients with CT-FFR ≤ 0.80 had a higher prevalence of typical angina (29.4% vs. 7.8%, p = 0.025) and atypical angina (29.4% vs. 6.5%, p = 0.016). Conclusion: Take-off level, intramural course, and slit-like ostium were the main predictors of abnormal CT-FFR values. Importantly, patients with abnormal CT-FFR values showed a higher prevalence of typical angina and atypical angina, indicating that CT-FFR is a potential tool to gauge the clinical relevance in patients with interarterial R-ACAOS.

Coronary Artery Lumen Segmentation Using Location–Adaptive Threshold in Coronary Computed Tomographic Angiography: A Proof-of-Concept

Shin Cheong-Il,Park Sang Joon,Kim Ji-Hyun,Yoon Yeonyee Elizabeth,Park Eun-Ah,Koo Bon-Kwon,Lee Whal 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.5

Objective: To compare the lumen parameters measured by the location-adaptive threshold method (LATM), in which the inter- and intra-scan attenuation variabilities of coronary computed tomographic angiography (CCTA) were corrected, and the scan-adaptive threshold method (SATM), in which only the inter-scan variability was corrected, with the reference standard measurement by intravascular ultrasonography (IVUS). Materials and Methods: The Hounsfield unit (HU) values of whole voxels and the centerline in each of the cross-sections of the 22 target coronary artery segments were obtained from 15 patients between March 2009 and June 2010, in addition to the corresponding voxel size. Lumen volume was calculated mathematically as the voxel volume multiplied by the number of voxels with HU within a given range, defined as the lumen for each method, and compared with the IVUS-derived reference standard. Subgroup analysis of the lumen area was performed to investigate the effect of lumen size on the studied methods. Bland-Altman plots were used to evaluate the agreement between the measurements. Results: Lumen volumes measured by SATM was significantly smaller than that measured by IVUS (mean difference, 14.6 mm3; 95% confidence interval [CI], 4.9–24.3 mm3); the lumen volumes measured by LATM and IVUS were not significantly different (mean difference, -0.7 mm3; 95% CI, -9.1–7.7 mm3). The lumen area measured by SATM was significantly smaller than that measured by LATM in the smaller lumen area group (mean of difference, 1.07 mm2; 95% CI, 0.89–1.25 mm2) but not in the larger lumen area group (mean of difference, -0.07 mm2; 95% CI, -0.22–0.08 mm2). In the smaller lumen group, the mean difference was lower in the Bland-Altman plot of IVUS and LATM (0.46 mm2; 95% CI, 0.27–0.65 mm2) than in that of IVUS and SATM (1.53 mm2; 95% CI, 1.27–1.79 mm2). Conclusion: SATM underestimated the lumen parameters for computed lumen segmentation in CCTA, and this may be overcome by using LATM.

Development of 'De novo' Aneurysm after Therapeutic Carotid Occlusion

Jin, Sung-Chul,Choi, Choong-Gon,Kwon, Do-Hoon The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.45 No.4

Carotid occlusion is an inevitable therapeutic modality for the treatment of complex aneurysms such as giant, traumatic, and intracavernous aneurysms. Late complications of carotid occlusion include 'de novo' aneurysm formation at a distant site because of hemodynamic changes in the circle of Willis. We report a case of de novo aneurysm in a vessel that appeared to be normal on initial angiography. The patient developed an anterior communicating artery aneurysm and marked growth of a basilar bifurcation aneurysm 9 years after trapping of the left internal carotid artery for the treatment of a ruptured large saccular aneurysm involving ophthalmic and cavernous segments. We propose that patients who undergo therapeutic carotid occlusion should be periodically followed by magnetic resonance angiography or computed tomographic angiography to evaluate the possibility of de novo aneurysm formation; this advice is in line with previous reports.

뇌동맥류 진단에 대한 전산화단층촬영 혈관조영술의 유용성

제현,정신,김태호,이제혁,박종근,김재휴,김수한,강삼석 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

In this study we have demonstrated the usefulness of the 3D-computed tomography in the evaluation of cerebral aneurysms as well as presenting the technical considerations and problems in its practical use. Between September 1994 and February 1995, we carried out computed tomographic angiography(CTA) in 29 patients using helical CT(General Electric HiSpeed Advantage unit). There were 15 females and 14 males, aged between 28 and 71 years. The CT angiography was performed for the following five reasons: 1) Further evaluation of a failed conventional cerebral angiography(three cases). 2) Impermissible condition of conventional cerebral angiography(six cases). 3) suspicion of aneurysm or subarachnoid hemorrhage on conventional CT scan(eleven cases). 4) Further evaluation of proven subarachnoid hemorrhage with no or suspicious cerebral angiographic finding(seven cases). 5) Follow-up of residual aneurysm sac(two cases). This early experience of computed tomographic angiography using helical CT was encouraging in uspect to its usefaluess in the evaluation of cerebral aneurysms in the arteries around the circle of Willis.

A Novel Noninvasive Technology for Treatment Planning Using Virtual Coronary Stenting and Computed Tomography-Derived Computed Fractional Flow Reserve

Kim, K.H.,Doh, J.H.,Koo, B.K.,Min, J.K.,Erglis, A.,Yang, H.M.,Park, K.W.,Lee, H.Y.,Kang, H.J.,Kim, Y.J.,Lee, S.Y.,Kim, H.S. Elsevier 2014 JACC. Cardiovascular interventions Vol.7 No.1

Objectives: This study sought to determine whether computational modeling can be used to predict the functional outcome of coronary stenting by virtual stenting of ischemia-causing stenoses identified on the pre-treatment model. Background: Computed tomography (CT)-derived fractional flow reserve (FFR) is a novel noninvasive technology that can provide computed (FFRct) using standard coronary CT angiography protocols. Methods: We prospectively enrolled 44 patients (48 lesions) who had coronary CT angiography before angiography and stenting, and invasively measured FFR before and after stenting. FFRct was computed in blinded fashion using coronary CT angiography and computational fluid dynamics before and after virtual coronary stenting. Virtual stenting was performed by modification of the computational model to restore the area of the target lesion according to the proximal and distal reference areas. Results: Before intervention, invasive FFR was 0.70 +/- 0.14 and noninvasive FFRct was 0.70 +/- 0.15. FFR after stenting and FFRct after virtual stenting were 0.90 +/- 0.05 and 0.88 +/- 0.05, respectively (R = 0.55, p < 0.001). The mean difference between FFRct and FFR was 0.006 for pre-intervention (95% limit of agreement: -0.27 to 0.28) and 0.024 for post-intervention (95% limit of agreement: -0.08 to 0.13). Diagnostic accuracy of FFRct to predict ischemia (FFR @?0.8) prior to stenting was 77% (sensitivity: 85.3%, specificity: 57.1%, positive predictive value: 83%, and negative predictive value: 62%) and after stenting was 96% (sensitivity: 100%, specificity: 96% positive predictive value: 50%, and negative predictive value: 100%). Conclusions: Virtual coronary stenting of CT-derived computational models is feasible, and this novel noninvasive technology may be useful in predicting functional outcome after coronary stenting. (Virtual Coronary Intervention and Noninvasive Fractional Flow Reserve [FFR]; NCT01478100)

Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD : A Randomized, Controlled, Open-Label Trial

Chang, Hyuk-Jae,Lin, Fay Y.,Gebow, Dan,An, Hae Young,Andreini, Daniele,Bathina, Ravi,Baggiano, Andrea,Beltrama, Virginia,Cerci, Rodrigo,Choi, Eui-Young,Choi, Jung-Hyun,Choi, So-Yeon,Chung, Namsik,Cole American College of Cardiology 2019 JACC. Cardiovascular imaging Vol.12 No.7

<P><B>Graphical abstract</B></P><P>[Figure]</P><P><B>Abstract</B></P><P><B>Objectives</B></P><P>This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure.</P><P><B>Background</B></P><P>Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis.</P><P><B>Methods</B></P><P>In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year.</P><P><B>Results</B></P><P>At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p < 0.001). Rates of normal ICA were 24.6% in the selective referral arm compared with 61.1% in the direct referral arm of the trial (p < 0.001).</P><P><B>Conclusions</B></P><P>In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198)</P>

뇌동맥류에 대한 3차원 전산화단층촬영 혈관조영술의 진단적 가치

최일승,김영수,고용,오성훈,오석전,김남규,김광명,이승로 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9

The authors have evaluated the efficacy of three dimensional computed tomographic angiography(3-DCTA) in diagnosing intracranial aneurysm. This literature studied thirty five patients harboring forty intracranial aneurysms using dynamic CT scan with intravenous contrast enhancement. After injection of 2㎎/㎏ of nonionic contrast material(Rayvist^(R)) intravenously, rapid dynamic CT scanning with thin section was performed. Three dimensional reconstruction was performed using the GE 9800 HR suface-rendering method with a threshold of about 100 Hounsfield units(HU). The authors comparatively analysed this 3-DCTA with conventional to surrounding vessels. While 3-DCTA clearly detected 38 aneurysms, conventional angiography did 37 ones. There was no significant difference between 3-DCTA and conventional angiography in demonstrating aneurysmal direction, but 3-DCTA was superior to conventional angiography in demonstrating aneurysmal shape, its neck and surrounding vascular structures. 3-DCTA showed deliberate anatomy of aneurysm and adjacent vessels through 3 dimensional image, and its operative view is helpful in surgical planning 3-DCTA might be expected to substitute for conventional angiography in the near future.

Safe Completion of Laparoscopic Anterior Resection in a Patient With a Solitary Pelvic Kidney: A Case Report

박병관,박용검,김범규 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.1

Pelvic kidney, an ectopic renal mass caused by developmental failure, is a rare condition. Here, we report a case of laparoscopic anterior resection in a patient with a solitary pelvic kidney. A 76-year-old man was diagnosed as having rectosigmoid colon cancer. Preoperative computed tomography revealed a left ectopic kidney in his pelvis. Computed tomographic angiography and retrograde pyelography were performed preoperatively to identify the renal vessels and the ureter. To keep the surgical plane intact for complete mesocolic excision, a complete laparoscopic anterior resection was safely performed without open conversion, and there was no injury to the pelvic kidney. The patient was discharged on postoperative day eight without any complication. No deterioration of renal function was observed after surgery. This report describes a case of laparoscopic anterior resection that was safely performed without conversion to open surgery in a patient with a pelvic ectopic kidney.

Willis환 내 뇌동맥류 진단시 전산화단층촬영 뇌혈관 조영술의 유용성

이혁기,조재훈,이성락,강동기,김상철,Lee, Hyuk Gi,Cho, Jae Hoon,Lee, Sung Lak,Kang, Dong Gee,Kim, Sang Chul 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Objective : The purpose of this study was to compare computed tomographic angiography(CTA) with conventional cerebral angiography(CCA) and to assess usefulness of CTA in detection and anatomic definition of intracranial aneurysms of the circle of Willis in subarachnoid hemorrhage. Patients and Methods : Fifty consecutive patients with known or suspected intracranial saccular aneurysms underwent CTA with preoperative CCA from 1997 to 1999. Using surface shaded display post-processing technique, CTA was interpreted for the presence, location of aneurysms and anatomic features. The image obtained with CTA was then compared with CCA image. Results : In 47 patients, CCA revealed 57 cerebral aneurysms and CTA revealed 54 aneurysms. Two of the 57 cerebral aneurysms were located outside of the imaging volume of CTA and one case was misdiagnosed. The sensitivity of CTA was 94.7% and the specificity was 100%. The results obtained with CTA were, compared with the results obtained with CCA, equal in determining dome shape, direction and lobularity. However, CTA provided a 3-dimensional representation of aneurysmal lesion very useful for surgical planning. Moreover, CTA was useful for rapid and relatively noninvasive detection of aneurysms in the circle of Willis. Conclusion : CTA can be a diagnostic tool for the patients with acute subarachnoid hemorrhage due to a ruptured aneurysm of the circle of Willis and provides adequate anatomic detail for surgical planning, especially to complex cerebral aneurysms. However, we think CCA is necessary because of CTA limitations including its difficulty in detecting unusually located aneurysms(including those in cavernous sinus or distal artery) and combined vascular lesion (including arteriovenous malformation) and acquiring dynamic flow information.