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Objectives@#The need for interoperability at the national level was highlighted in Korea, leading to a consensus on the importance of establishing national standards that align with international technological standards and reflect contemporary needs. This article aims to share insights into the background of the recent national health data standardization policy, the activities of the Health Data Standardization Taskforce, and the future direction of health data standardization in Korea. @*Methods@#To ensure health data interoperability, the Health Data Standardization Taskforce was jointly organized by the public and private sectors in December 2022. The taskforce operated three working groups. It reviewed international trends in interoperability standardization, assessed the current status of health data standardization, discussed its vision, mission, and strategies, engaged in short-term standardization activities, and established a governance system for standardization. @*Results@#On September 15, 2023, the notice of “Health Data Terminology and Transmission Standards” in Korea was thoroughly revised to improve the exchange of health information between information systems and ensure interoperability. This notice includes the Korea Core Data for Interoperability (KR CDI) and the Korea Core Data Transmission Standard (HL7 FHIR KR Core), which are outcomes of the taskforce’s efforts. Additionally, to reinforce the standardized governance system, the Health-Data Standardization Promotion Committee was established. @*Conclusions@#Active interest and support from medical informatics experts are needed for the development and widespread adoption of health data standards in Korea.
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BackgroundThere are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis.MethodsWe analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively.ResultsCompared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; P=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; P=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; P<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; P<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (P=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (P=0.023).ConclusionAsymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.
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PURPOSE@#To describe imaging and clinical findings for a left ventricular noncompaction (LVNC) in the adult.@*MATERIALS AND METHODS@#From 2000 to 2014, 63 patients were diagnosed with LVNC by echocardiography, computed tomography, and magnetic resonance imaging at our hospital. Baseline characteristics, clinical manifestations, combined cardiac or systemic anomalies, and imaging findings were reviewed. We made a comparison between the isolated and combined disease groups.@*RESULTS@#Among 63 patients with LVNC, 32 (51%) patients did not have combined cardiac anomalies (isolated disease group). The mean age at the initial diagnosis was higher in the isolated than in the combined disease group (54.2 years vs. 40.2 years, p < 0.001). The combined disease group presented symptoms more frequently at initial diagnosis than the isolated disease group (94% vs. 75%, p = 0.082). Heart failure symptoms were the most common adverse events (60.3% in all patients). Thromboembolic events developed in 20 patients, and were more frequent in the combined disease group than in the isolated disease group (39% vs. 26%, p = 0.279). The most common cardiac abnormality was dilated cardiomyopathy (n = 15, 24%). There was no significant difference in the mean noncompacted/compacted ratios between both of the disease groups.@*CONCLUSION@#Isolated and combined LVNC disease groups showed differences in age at diagnosis and clinical manifestations. The clinical and imaging findings may be helpful to better understand LVNC.
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In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.
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Humains , Aire sous la courbe , Asiatiques , Prise de décision clinique , Consensus , Maladie des artères coronaires , Échocardiographie , Électrocardiographie , Cardiopathies , Imagerie par résonance magnétique , Méthodes , Tomographie par émission de positons , Scintigraphie , TomoscintigraphieRÉSUMÉ
BACKGROUND: The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD. METHODS: We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as > or =50% diameter stenosis in at least one coronary artery. RESULTS: Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 micromol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028). CONCLUSION: Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.
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Humains , Angiographie , Bilirubine , Marqueurs biologiques , Sténose pathologique , Maladie des artères coronaires , Sténose coronarienne , Vaisseaux coronaires , Études transversales , Diabète , Diagnostic , Modèles logistiques , Tomodensitométrie multidétecteurs , Odds ratio , Prévalence , Courbe ROCRÉSUMÉ
No abstract available.
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Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.
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Femelle , Humains , Mâle , Adulte d'âge moyen , Coronarographie/méthodes , Maladie des artères coronaires/physiopathologie , Pronostic , Risque , Tomodensitométrie/méthodesRÉSUMÉ
Data pools and their integration are fueling the big data revolution in health care with the recent advances in information technology. Korea has shown tremendous promise in the utilization of big data for its advanced technology, computerized health data, and unique identifiers. However, the Personal Information Protection Act (PIPA) severely limits access to personal identifiers, which has discouraged the use of health data even for the public good. In contrast, western countries have focused on research without the use of identifiers, which has augmented the use of the available data while maintaining and respecting privacy; they have allowed some exemptions of informed consent and utilized limited data sets, which have the identifiers removed. The amount of research output has increased rapidly and an in-depth understanding of cancer has been made possible based on the linkage of Surveillance, Epidemiology, and End Results (SEER) and Medicare in the US. More than 700 projects covering a wide range of medical areas have been conducted, which has led to changes in clinical practice based on the Western Australian Data Linkage System. Although rare, evidence-driven decisions based on data linkage have been found in some cases in Korea; the adoption of prostate cancer screening as a national screening program was suspended as its cost-effectiveness has not been verified on the basis of data linkage by the National Evidence-Based Healthcare Collaboration Agency. For the active use of health data, there is an urgent need to amend PIPA, prepare regulations for data analysis, and foster collaboration among data-related institutions. Great projects based on data linkage will guarantee the world's leading research output and will be major sources for moving forward to success.
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Humains , Sécurité informatique , Comportement coopératif , Ensemble de données , Prestations des soins de santé , Épidémiologie , Pratique factuelle , Mémorisation et recherche des informations , Consentement libre et éclairé , Corée , Dépistage de masse , Medicare (USA) , Vie privée , Tumeurs de la prostate , Contrôle social formel , Statistiques comme sujetRÉSUMÉ
BACKGROUND AND OBJECTIVES: The objective of this study was to determine whether long-term exercise training will improve age-related cardiac metabolic derangement using proton magnetic resonance (MR) spectroscopy. MATERIALS AND METHODS: Young and old male Fischer 344 rats were assigned to sedentary controls groups {young control (YC) group-3 months of age: YC, n=10; old control (OC) group-22 months of age: OC, n=10}, and an exercise training group (OT, n=5). After 12-week of treadmill exercise training, MR spectroscopy at 4.7 T was performed to assess myocardial energy metabolism: measurements of myocardial creatine-to-water ratio (Scr/Sw) were performed using the XWIN-NMR software. RESULTS: Exercise capacity was 14.7 minutes greater in OT than that in OC (20.1+/-1.9 minutes in OT, 5.4+/-2.3 minutes in OC; p0.05). The creatine-to-water ratios in the interventricular septa of YC did not differ significantly from that of OT (0.00131+/-0.00025 vs. 0.00127+/-0.00031; p=0.37). However, OC showed significant reduction in creatine-to-water ratio compared to OT (0.00096+/-0.00025 vs. 0.00127+/-0.00031; p<0.001). Mean total creatine concentrations in the myocardium were similar between YC and OT (13.3 +/-3.6 vs. 11.5+/-4.1 mmol/kg wet weight; p=0.29). In contrast, the mean total creatine concentration of OC was significantly reduced compared to OT (6.8+/-3.2 vs. 11.5+/-4.1 mmol/kg wet weight; p=0.03). CONCLUSION: Our findings suggest that long-term exercise training in old rats induced prevention of age-related deterioration in myocardial metabolism.
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Animaux , Humains , Mâle , Rats , Créatine , Spectroscopie par résonance magnétique , Magnétisme , Aimants , Myocarde , Protons , Analyse spectraleRÉSUMÉ
OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.
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Femelle , Humains , Mâle , Adulte d'âge moyen , Produits de contraste , Pontage aortocoronarien , Maladie coronarienne/chirurgie , Acide gadopentétique , Interprétation d'images assistée par ordinateur , Imagerie par résonance magnétique/méthodes , Péricarde/chirurgie , Études rétrospectives , Statistique non paramétrique , Septum interventriculaire/physiopathologieRÉSUMÉ
OBJECTIVE: We wanted to evaluate the effect of the number of diffusion-sensitizing gradient directions on the image quality for evaluating myocardial anisotropy and fiber tracking by using in vitro diffusion tensor MR imaging (DT-MRI). MATERIALS AND METHODS: The DT-MR images, using a SENSE-based echoplanar imaging technique, were acquired from ten excised porcine hearts by using a 3T MR scanner. With a b-value of 800 s/mm2, the diffusion tensor images were obtained for 6, 15 and 32 diffusion-sensitizing gradient directions at the midventricular level. The number of tracked fibers, the fractional anisotropy (FA), and the length of the tracked fibers were measured for the quantitative analysis. Two radiologists assessed the image quality of the fiber tractography for the qualitative analysis. RESULTS: By increasing the number of diffusion-sensitizing gradient directions from 6 to 15, and then to 32, the FA and standard deviation were significantly reduced (p < 0.01), and the number of tracked fibers and the length of the tracked fibers were significantly increased (p < 0.01). The image quality of the fiber tractography was significantly increased with the increased number of diffusion-sensitizing gradient directions (p < 0.01). CONCLUSION: The image quality of in vitro DT-MRI is significantly improved as the number of diffusion-sensitizing gradient directions is increased.
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Animaux , Anisotropie , Imagerie par résonance magnétique de diffusion/méthodes , Myocarde/cytologie , SuidaeRÉSUMÉ
A benign metastasizing leiomyoma is a rare condition that affects women with a history of uterine leiomyoma, usually after a myomectomy or hysterectomy. Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging from a few millimeters to several centimeters in diameter and scattered among the normal interstitium. We report a case of a benign metastasizing leiomyoma that manifested with multiple cavitary nodules in a 46-year-old woman with no previous history of a myomectomy or hysterectomy.
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Femelle , Humains , Adulte d'âge moyen , Hystérectomie , Léiomyome , Poumon , Nodules pulmonaires multiples , Métastase tumorale , UtérusRÉSUMÉ
OBJECTIVE: We wanted to compare the transaxial source images with the optimized three plane, thin-slab maximum intensity projection (MIP) images from electrocardiographic (ECG)-gated cardiac CT for their ability to detect hemodynamically significant stenosis (HSS), and we did this by means of performing a receiver operating characteristic (ROC) analysis. MATERIALS AND METHODS: Twenty-eight patients with a heart rate less than 66 beats per minute and who were undergoing both retrospective ECG-gated cardiac CT and conventional coronary angiography were included in this study. The contrast-enhanced CT scans were obtained with a collimation of 16x0.75-mm and a rotation time of 420 msec. The transaxial images were reconstructed at the mid-diastolic phase with a 1-mm slice thickness and a 0.5-mm increment. Using the transaxial images, the slab MIP images were created with a 4-mm thickness and a 2-mm increment, and they covered the entire heart in the horizontal long axis (4 chamber view), in the vertical long axis (2 chamber view) and in the short axis. The transaxial images and MIP images were independently evaluated for their ability to detect HSS. Conventional coronary angiograms of the same study group served as the standard of reference. Four radiologists were requested to rank each image with using a five-point scale (1 = definitely negative, 2 = probably negative, 3 = indeterminate, 4 = probably positive, and 5 = definitely positive) for the presence of HSS; the data were then interpreted using ROC analysis. RESULTS: There was no statistical difference in the area under the ROC curve between transaxial images and MIP images for the detection of HSS (0.8375 and 0.8708, respectively; p > 0.05). The mean reading time for the transaxial source images and the MIP images was 116 and 126.5 minutes, respectively. CONCLUSION: The diagnostic performance of the MIP images for detecting HSS of the coronary arteries is acceptable and this technique's ability to detect HSS is comparable to that of the transaxial source images.
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Adulte d'âge moyen , Mâle , Humains , Femelle , Sujet âgé , Adulte , Tomodensitométrie/méthodes , Études rétrospectives , Courbe ROC , Interprétation d'images assistée par ordinateur , Rythme cardiaque , Électrocardiographie , Sténose coronarienne/imagerie diagnostique , CoronarographieRÉSUMÉ
PURPOSE: To examine whether the ACR phantom could be used in quality standards for magnetic resonance imaging (MRI) instruments in Korea. MATERIALS AND METHODS: We conducted the phantom test using the ACR MRI phantom in 20 MRI instruments currently used in Korea. According to ACR criteria, we acquired the phantom images which were then assessed by the following seven tests: geometric accuracy, high spatial resolution, slice thickness accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting, and low contrast object detectability. The phantom images were interpreted by three experienced radiologists according to ACR criteria. Then, we examined the failure rate of each test and evaluated the inter-observer variation in the measurements and test failure. RESULTS: The failure rate of each test could be broken into the following components: geometric accuracy (11-21%), high contrast spatial resolution (10-15%), slice thickness accuracy (6-22%), slice position accuracy (5-17%), image intensity uniformity (6%), percent signal ghosting (16%), and low contrast object detectability (8-10%). In this series, all the failure rates were less than 30%. In addition, no inter-observer variation was seen in the measurements and test failure. CONCLUSION: ACR MRI phantom promises to be established as the standard phantom for MRI instruments in Korea because of its objectivity in assessing the phantom images.
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Corée , Imagerie par résonance magnétique , Biais de l'observateurRÉSUMÉ
PURPOSE: We wanted to evaluate the accuracy of using ECG-gated CT angiography (CTA) for the assessment of coronary bypass graft patency. MATERIALS AND METHODS: This study included 48 patients who underwent both CTA and conventional angiography to evaluate coronary bypass graft patency. CTA was performed with a 16-detector row multislice CT scanner. We calculated the sensitivity and specificity of CTA to detect occlusion of bypass graft that was equal to or greater than 50% of the expected diameter. Conventional angiography served as a gold standard. A total 160 grafts were evaluated. The diagnostic accuracy was evaluated according to a variety of factors (heart rate, types of bypass graft, target vessel, and surgical techniques). RESULTS: The overall sensitivity, specificity and accuracy of CTA were 83.9%, 95.4% and 93.1%, respectively. There was no significant statistical difference for each factor according to Fisher's exact test. Although the grafts anastomosed to the left circumflex arterial branches and a high heart rate showed a statistically significant high risk of misdiagnosis on the simple logistic regression test, a high heart rate was the only significant factor on the multiple logistic regression test (odds, 5.9). CONCLUSION: CTA provides for good noninvasive evaluation of the coronary bypass graft patency. The heart rate and the anastomosed vessel are factors that can influence the accuracy.
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Humains , Angiographie , Erreurs de diagnostic , Rythme cardiaque , Coeur , Modèles logistiques , Sensibilité et spécificité , TransplantsRÉSUMÉ
OBJECTIVE: We wanted to describe the retrospective CT features of subtle pleural metastasis without large effusion that would suggest inoperable lung cancer. MATERIALS AND METHODS: We enrolled 14 patients who had open thoracotomy attempted for lung cancer, but they were proven to be inoperable due to pleural metastasis. Our study also included 20 control patients who were proven as having no pleural metastasis. We retrospectively evaluated the nodularity and thickening of the pleura and the associated pleural effusion on the preoperative chest CT scans. We reviewed the histologic cancer types, the size, shape and location of the lung cancer and the associated mediastinal lymphadenopathy. RESULTS: Subtle pleural nodularity or focal thickening was noted in seven patients (50%) having pleural metastasis and also in three patients (15%) of control group who were without pleural metastasis. More than one of the pleural changes such as subtle pleural nodularity, focal thickening or effusion was identified in eight (57%) patients having pleural metastasis and also in three patients (15%) of the control group, and these findings were significantly less frequent in the control group patients than for the patients with pleural metastasis (p = 0.02). The histologic types of primary lung cancer in patients with pleural metastasis revealed as adenocarcinoma in 10 patients (71%) and squamous cell carcinoma in four patients (29%). The location, size and shape of the primary lung cancer and the associated mediastinal lymphadenopathy showed no significant correlation with pleural metastasis. CONCLUSION: If any subtle pleural nodularity or thickening is found on preoperative chest CT scans of patients with lung cancer, the possibility of pleural metastasis should be considered.
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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Adénocarcinome/imagerie diagnostique , Carcinome épidermoïde/imagerie diagnostique , Tumeurs du poumon/anatomopathologie , Épanchement pleural malin/anatomopathologie , Tumeurs de la plèvre/imagerie diagnostique , Soins préopératoires , Études rétrospectives , TomodensitométrieRÉSUMÉ
Various invasive and non-invasive imaging techniques have been used for the diagnosis of cardiac disease. The recently introduced multidetector row CT (MDCT) shows rapid scan speed, high temporal resolution and large volume coverage in a single breath-hold. MDCT opens a new horizon for cardiac imaging because noninvasive coronary artery imaging has become feasible using MDCT. In this article, we illustrate the technical aspects of coronary CT angiography using MDCT.
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Angiographie , Coronarographie , Vaisseaux coronaires , Diagnostic , Cardiopathies , Tomodensitométrie multidétecteursRÉSUMÉ
PURPOSE: To compare a free-breathing, navigator-echo-gated, three-dimensional, inversion-recovery, gradient-echo, MR pulse sequence (3D-MRI) with standard, multiple breath-hold, two-dimensional, inversion-recovery, gradient-echo MR (2D-MRI) for the evaluation of delayed hyperenhancement of nonviable myocardium in patients with chronic ischemic heart disease. MATERIALS AND METHODS: Ten patients with chronic ischemic heart disease were enrolled in this study. MRI was performed on a 1.5-T system. 3D-MRI was obtained in the short axis plane at 10 minutes after the administration of Gd-DTPA (0.2 mmol/kg, 4 cc/sec). Prospective gating of the acquisition based on the navigator echo was applied. 2D-MRI was performed immediately after finishing 3D-MRI. The area of total and hyperenhanced myocardium measured on both image sets was compared with paired Student t-test and Bland-Altman method. By using a 60-segment model, the transmural extent and segmental width of the hyperenhanced area were recorded by 3-scale grading method. The agreement between the two sequences was evaluated with kappa statistics. We also evaluated the agreement of hyperenhancement among the three portions (apical, middle and basal portion) of the left ventricle with kappa statistics. RESULTS: The two sequences showed good agreement for the measured area of total and hyperenhanced myocardium on paired t-test (p=0.11 and p=0.34, respectively). No systematic bias was shown on Bland-Altman analysis. Good agreement was found for the segmental width (Kappa=0.674) and transmural extent (Kappa=0.615) of hyperenhancement on the segmented analysis. However, the agreement of the transmural extent of hyperenhancement in the apical segments was relatively poor compared with that in the middle or basal portions. CONCLUSION: This study showed good agreement between 3D-MRI and 2D-MRI in evaluation of non-viable myocardium. Therefore, 3D-MRI may be useful in the assessment of myocardial viability in patients with dyspnea and children because it allows free-breathing during the examination.
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Enfant , Humains , Axis , Biais (épidémiologie) , Dyspnée , Acide gadopentétique , Coeur , Ventricules cardiaques , Imagerie par résonance magnétique , Ischémie myocardique , Myocarde , Études prospectivesRÉSUMÉ
OBJECTIVE: To evaluate, using localized proton magnetic resonance spectroscopy (1H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. MATERIALS AND METHODS: Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and 99mTc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized 1H-MRS, and after revascularization surgery, four patients underwent follow-up 1H-MRS. RESULTS: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. CONCLUSION: Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, 1H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.
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OBJECTIVE: To compare observer performance using liquid-crystal display (LCD) and cathode-ray tube (CRT) monitors in the interpretation of soft-copy chest radiographs for the detection of small solitary pulmonary nodules. MATERIALS AND METHODS: By reviewing our Medical Center's radiologic information system, the eight radiologists participating in this study (three board-certified and five resident) retrospectively collected 40 chest radiographs showing a solitary noncalcified pulmonary nodule approximately 1 cm in diameter, and 40 normal chest radiographs. All were obtained using a storage-phosphor system, and CT scans of the same patients served as the gold standard for the presence of a pulmonary nodule. Digital images were displayed on both high-resolution LCD and CRT monitors. The readers were requested to rank each image using a five point scale (1 = definitely negative, 3 = equivocal or indeterminate, 5 = definitely positive), and the data were interpreted using receiver operating characteristic (ROC) analysis. RESULTS: The mean area under the ROC curve was 0.8901+/-0.0259 for the LCD session, and 0.8716+/-0.0266 for the CRT session (p > 0.05). The reading time for the LCD session was not significantly different from that for the CRT session (37.12 and 41.46 minutes, respectively; p = 0.889). CONCLUSION: For detecting small solitary pulmonary nodules, an LCD monitor and a CRT monitor are comparable.