고주파 전극도자절제술 전 이중에너지 CT를 이용한 좌심방이의 혈전과 혈류정체 구별에 관한 연구 = A Study on the Distinction between Thrombus and Blood Stasis in Left Atrial Appendage using Dual Energy CT before Radiofrequency Catheter Ablation

국문 초록 (Abstract)

고주파전극도자절제술 전 이중에너지 CT와 경식도 심장초음파 검사를 시행한 심방세동 환자들을 대상으로 혈전과 혈류정체의 구별에 있어 DE blended image, Iodine maps, Zeff, 70 & Sn150 kV의 영상에서 Cut-off value를 도출하고, 이를 적용한 정량적 평가의 유용성과 최적의 평가 방법에 대해서 연구하고자 하였다. 선행연구는 혈전 환자 18명, 혈류정체 환자 80명을 대상으로 CT 판독 결과와 TEE 검사 결과의 일치율을 분석하였고, DECT 각각의 영상에서 오름대동맥과 좌심방이의 충만결손 부위에 ROI를 설정하여 비율을 측정하였다. ROC curve를 통해 각각의 민감도와 특이도를 분석하고 Cut-off value를 구하였다. 후행연구는 혈전 환자 5명, 혈류정체 환자 13명을 대상으로 DECT 각각의 영상에 Cut-off value를 적용하여 정량적으로 평가하였고, TEE 검사 결과와 비교하여 일치율을 분석하였다. 선행연구에서는 정성적 평가의 CT와 TEE 검사 결과 간의 일치율은 80.6%이다. DECT로 획득한 측정 방법의 ROC curve 분석 결과에서 민감도는 모두 100%로 나타났으며, 특이도와 AUC는 Iodine maps에서 가장 높게 측정되었고 Zeff에서 가장 낮게 측정되었다. Cut-off value를 적용하여 정량적으로 CT를 평가한 후행연구에서는 Iodine maps을 활용한 측정 방법의 일치율이 93.9%로 선행연구보다 약 13.3% 상승하였다. RFCA 시술 전 TEE 검사에 제한이 있는 환자들을 대상으로 Iodine maps의 Cut-off value를 활용한 정량적 평가 방법이 좌심방이의 혈전을 감별하기 위한 TEE 검사의 대안이 될 수 있을 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

In atrial fibrillation patients who performed Dual Energy Computed Tomography and Transesophageal Echocardiography before Radiofrequency Catheter Ablation, Cut-off values were derived from images of Dual Energy blended image, iodine maps, Zeff, and 70 & Sn150 kV in distinguishing thrombus from blood stasis, and the usefulness and optimal evaluation method were studied. The previous study analyzed the concordance rate of CT reports and TEE results in 18 thrombus patients and 80 blood stasis patients, and the ratio was measured by setting ROI in the filling defect of the ascending aorta and left atrial appendage in each DECT image. Sensitivity and specificity were analyzed through the ROC curve and Cut-off value was obtained. The follow-up study quantitatively evaluated 5 thrombus patients and 13 blood stasis patients by applying Cut-off value to images of DECT, and analyzed the concordance rate by comparing the results of the TEE. In previous studies, the concordance rate between CT and TEE results of qualitative evaluation was 80.6%. The ROC curve analysis results of the measurement method obtained with DECT showed that all sensitivity was 100%, and specificity and AUC were measured the highest in Iodine maps. In subsequent studies, which quantitatively evaluated CT by applying Cut-off value, the concordance rate of measurement methods using iodine maps was 93.9%, up about 13.3% from previous studies. It is believed that a quantitative evaluation method using the Cut-off value of iodine maps for patients with limited TEE before RFCA can be an alternative to the TEE to distinguish thrombus in the left atrial appendage.

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