대상 및 방법 - 대한전산화단층기술학회

unkindnesskindΠολεοδομικά Έργα

15 Νοε 2013 (πριν από 3 χρόνια και 9 μήνες)

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1


Abstract


The purpose of this study was to evaluate the image quality and diagnostic value of
multi
-
planar reformat (MPR) of abdominal CT performed

with multi
-
detector row spiral
technique (MDCT).
266

patients were referred for an abdominal MDCT angiograp
hy.
No significant

differences in image quality and in the number of lesions detected were
found between axial and MPR images. Additional diagnostic value to axial images
could be obtained with MPR display
.


1. Introduction

Computed tomography of the liver

and the upper abdomen

is a well
-
established tool for
a variety of indications.
However, it faces strong competition from both ultrasound

and
MRI.

One of the traditional limitations of CT has been

the confinement to axial image
acquisition. Early on MPRs

E
arly MPRs
have been used for visualization of axial CT
data in
examining
arbitrary

planes

and the utility of this approach using SDCT has been

previously documented
.
However, the image quality

of MPRs was restricted by the
limited z
-
axis resolution

that ca
n be archived
within reasonable scan time and

allowed
radiation doses in conventional spiral CT.

With

the advent of MDCT, data sets with almost isotropic voxels can be routinely
acquired during a single breath
-
hold and

reformatted in any desired plane. Du
e to their
unrivalled

z
-
resolution, the MDCT images appear better suited for

MPR than the
conventional spiral CT images
.

This may foster the routine use of coronal or sagittal

reformats for CT evaluation of
abdominal lesions, which so

far reserved for mag
netic resonance imaging. This
hypothesis

was tested in the present study by assessing the image quality

and diagnostic
values
of MPR of abdominal CT examinations

performed with multi
-
detector row spiral
technique.


2. Materials and methods

266
patients wit
h suspected hepatic

disease referred for CT
-
angio, pancreas, biliary,
liver dynamic

examinations of liver were enrolled

in this study. There were
95

females
and
171

males, aged

from 0 to 87 years (mean age: 54 years). Of all patients,

there were
21 cases o
f
abdomen

CT, 80 cases of abdo
-
pelvis, 29 cases of CT
-
angio, 34 cases of
billiary & pancreas, and 102cases of liver dynamic.

1)

Equipment & contrast media


Multi

detector : SIEMENS Somatom sensation 16


2

Workstation: Leonardo (SIEMENS)

Auto
-
injector : MEDR
AD (ENVISION CT)

Contrast media: IOPAMIRO 370mg/ml

PACS system: Path
-
speed 8.1 (GE)


2)

Methord

The entire upper abdomen was acquired c
ranio
-
c
aud
ally at 120 k
vp

and
150

Eff.
mA
during

on
e breath
-
hold period. Contrast enhancement was achieved by an intravenous

bolus injection of 120 ml of a nonionic

contrast agent (
IOPAMIRO

300,
ILSUNG
pharma
),

injected at
the

flow rate of 4 ml/s using a

MEDRAD

power injector
.
The

table
speed of 6 mm/0.5 s rotation

resulted in pitch 1.
we used
the

bolus tracking technique
whose

baseline threshold value is 100

on the celiac artery(T12 ~ L1).

The

Scan delays
of 12
sec

and

20sec

were used to acquire
the

data during arterial and venous
.


SCAN PARAMETER

1. Detector collimation: 0.75mm

2. Slice thick: 3mm, 5mm (Axial image)


0.75mm (MP
R source image)

3. Reformat thickness : 3mm, 5mm

4. Feed / Rotation: 12mm( pitch:1)

5. Scan time:Abdomen ; 9sec
±
1.3sec ( 1 Scan range 20cm

24cm )


Abdomen+pelvis : 19sec
±
2.1sec(1 Scan range 40cm
-
50cm)


The entire upper abdomen was

reconstructed

with a 1.25
-
mm slice thickness
.
All
reconstructed MDCT data were then transferred from

CT scanner to an interactive
three
-
dimensional workstation

(
Leonardo,

Siemens, Forchheim, Germany) and

reformatted (front
-
to
-
back, side
-
to
-
side) on coronal and

sagittal

planes

using 5mm,
3mm thickness
.

Both the axial

and MPR images were displayed at the same soft tissue

window setting (width: 350, center: 40). Measurements of the contrast enhancement and
the noise

level on MDCT images were performed
on the image of PACS

by placing

a
circular regions of interest in the
descending aorta
.
That was
to evaluate the MPR

to the
axial
image
as comprehensive visualization of the

lesion location, features and
relationship to its surrounding

structure
,

and helpfulness to the axial
images.

We
have evaluated the value

10 times(total 40 times) respectively with 3mm,5mm
thickness of slice a patient.
Statistical analyses were performed using the
MINITAB(this program was used in GE 6 sigma).



3

Ratings

scores of image quality and visualizat
ion of organs were

compared by
calculating means
.


.

3. Results

Depending on the dimensions of the patient, the scan

duration of MDCT studies ranged
from
8

to
1
1s
ec
(
1phase)
to cover the entire upper abdomen with
0.75
-
mm

collimation.
The time of source imag
e reconstruction used in MPR recon took about 4min, and t
he
total procedure for processing MPR
took 1 min on average
for each patient.
we
evaluated the circular ROI
which is

the image quality of axial & MPR and
listed
. But n
o
significant differences in the

rating scores of image quality were found between axial
and

MPR images on each category
. The
calculating means

of Arterial phase in axial
image displayed on the PACS monitor were 355.8(thickness 3mm), 358.35( thickness
5mm ),
359.45(
thickness 3mm ),
and

3
52.65( thickness 5mm ) in MPR image
,

respectively( the difference of the each value was 3.55 in 3mm, 5.70 in 5mm).

The ROI
measurements from each sample to reduce the range of the measurement error were
412.4 for Axial image thickness 3mm, 413.7 for 5mm, 4
08.7 for MPR thickness 3mm,
and 411.2 for 5mm.
Although there were no significant differences in the rating scores
of visualization of organs when the scores were

compared between the axial images and
MPRs in combination

with axial images, all anatomic str
uctures

evaluated were better
displayed with the MPRs
.

The capability of MDCT MPRs to display

the pancreas is also greatly improved. The
good contrast

enhancement allowed clear visualization of the entire course

and key
structures of the pancreas

MPR also
provided the conspicuity

of small lesion and facilitated the visualization of
the

course and the caliber of the aorta and its branches, such as

the superior mesenteric
artery as shown in Fig
.?

Such

illustrations may be helpful in visualizing complex anatom
y

and diagnosing
lesions with increased confidence.

Now, a
pplication of MPR

which has
limited

their role
can be routinely acquired,

reformatted in any desired plane and highly recommended


4. Discussion

When we compared the speed between 16slice of MDCT an
d 8slice of MDCT, the total
scanning time was similar to both of those but the quality of image and time of recon
were significantly improved
. Therefore, large anatomical areas,

such as the entire
abdomen or chest, can be imaged virtually

free of motion ar
tifacts.


4

MPR is a powerful tool to display and communicate

complex anatomic and pathologic
information.

).

However, it

is crucial to have a fine longitudinal resolution for MPR

display to be useful
.

With the advent of sub
-
second multi
-
detector row CT
, it i
s possible
to reconstruct real time MPR image.

We took advantage of the increased information that thin
-
section

MDCT can facilitate
the lesion visualization,

location and relationship to surrounding structures by per
-
forming

MPR in each desirable plane. Wi
th thinner sections

of MDCT, not only image
quality is improved, but lesions

can be also detected more reliably.

This technique

expands the conventional roles of
axial CT scans and

provides additional diagnostic value
.

There were some of lack points:



PACS
cannot display HU value



The image on PACS and CT date cannot be compared directly since the ROI
value is a transformed value from pixel value



ROI value on L
i
ver and other focus was not measured and compared.



The MPR source image was inconvenient to be stor
ed since its number is too
many

Further study should distinguish the correlation between axial and MPR over the change
of collimation and pitch.


서론


복부의

병소

부위를

진단하는데

있어

CT
촬영은

다양한

증상에

대하여

확실히


증된

검사

방법이다
.
그러나

최근

MRI


ULTRASOUND


강력한

경쟁에

직면하


있다
.

현재까지

복부
SCA
N


있어서

Routine


Axial image
에만

제한적으로

시행되어



.
초기

MPR Image


Axial CT Data


임의의

PLANE
으로

보는데

사용되어왔고

이에

대한

유용성은

이미

논문화

되었다
.


MPR
이나

MIP
같은

2
차적

Image


진단적

목적으로

사용되어왔지만

MPR Image


Quality


기존의

SPIRAL CT
에서

허용시간

내에

허용

피폭

선량으로

만들



있는
Z
축의

Resolution


한계점으로

인하여

제한되어왔다
.

그러나

MDCT


개발과

함께

거의

균등한

Voxel


채워진

Data




호흡에

얻을



있게

되었고

( ISOTROPIC RESOLUTION )
우리가

원하는

면에서의

다양한

Reformat


얻을



있게

되었다
.


MDCT(16channel)


비교할



없는

뛰어난

Z


Resolution
으로

MDCT(16channel) Image


기존의
SPIRAL CT
보다

훨씬




5

월등한

MPR Image


얻을



있다
. (
그림
1, 2, 3)











Image plane perpendicular to z
-
axis 12 slices, pitch 1.5 = pitch 18

그림
1
그림
2

이로

인하여

복부

CT EVALUTION


대한

Coronal, Sagittal Reformat


Routine
으로

사용하게

되었고

이는

MRI
영상과도

견줄만하다는

전제

하에

MDCT


이용
하여

최근

시행된

복부

CT


MPR Image


진단적

가치



Image Quality


분석


보고자

한다
.


-
3

-
2

-
1

0

1

2

3

-
0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

FWHM: 0.82 mm

1.02
mm

3.89
mm

0.9

1.0


0.5

0.75

1

1.25

1.5

0.5

1

1.5

2

2.5

3

3.5

4


measure
d








Z in mm

Pich

그림
3


6

L
i
v
e
r
-
D
y
b
i
l
-
p
a
n
C
T
-
a
n
g
i
o
A
b
d
-
P
e
l
A
b
d
o
m
e
n
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
6
.
0
5
.
5
5
.
0
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
e
d
i
a
n
V
a
r
i
a
b
l
e
:





5
.
0
0
0
0
0
1
.
3
3
2
2
7
5
.
2
2
3
9
8
M
a
x
i
m
u
m
3
r
d

Q
u
a
r
t
i
l
e
M
e
d
i
a
n
1
s
t

Q
u
a
r
t
i
l
e
M
i
n
i
m
u
m
N
K
u
r
t
o
s
i
s
S
k
e
w
n
e
s
s
V
a
r
i
a
n
c
e
S
t
D
e
v
M
e
a
n
P
-
V
a
l
u
e
:
A
-
S
q
u
a
r
e
d
:
6
.
0
0
0
0
0
1
.
5
8
0
0
8
5
.
5
7
3
0
1
7
.
0
0
0
0
0
7
.
0
0
0
0
0
5
.
5
0
0
0
0
4
.
0
0
0
0
0
3
.
0
0
0
0
0
2
6
6
-
1
.
5
4
2
1
9
-
1
.
5
E
-
0
1
2
.
0
8
9
6
6
1
.
4
4
5
5
6
5
.
3
9
8
5
0

0
.
0
0
0
1
8
.
8
0
9
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
e
d
i
a
n
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

S
i
g
m
a
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
A
n
d
e
r
s
o
n
-
D
a
r
l
i
n
g

N
o
r
m
a
l
i
t
y

T
e
s
t
D
e
s
c
r
i
p
t
i
v
e

S
t
a
t
i
s
t
i
c
s
대상



방법




2003


2


17
일부터

2003


3


14
일까지의

본원에

내원한

환자



ABDOM


ABDOMEN PELVIS, CT
-
ANGIO
검사와

BILIARY, PANCREAS CT

리고

LIVER DINAMIC
검사를

시행한

환자

266
명을

대상으로

하였다
.
남녀

구성은

남자

171

,
여자
95


이었고

연령

분포는

0


~ 87

(
평균

54

)
이었다
.


가운


ABDOM CT


21


이고
, ABDOMEN PELVIS 80

,CT
-
ANGIO 29


BILIARY,
PANCREAS 34

, LIVER DINAMIC 102


이었다
.



1.

226
명의


DATA
수집기간
: 2003/02/17~03/14
까지

검사부위







A扤b浥m



4



A扤b浥m+健Pvis








-
Angio







䉩汩慲aⰠP慮捲敡c







䱩v敲 D祮慭ic





㄰1


(㈰〳/0㈯ㄷ~㈰0㌯0㌯1㐩

ㄷ1



㈶2



2.
복부검사의

종류별

분포도













1.
사용기기



조영제


Multi

detector : SIEMENS Somatom sensation 16

Workstation: Leonardo (SIEMENS)


7

Auto
-
injector : MEDRAD (ENVISION CT)

Contrast media: IOPA
MIRO 370mg/ml

PACS SYSTEM: Pathspeed 8.1 (GE)


2.
검사방법








주입속도는

4ml/sec


Total 120ml


기준으로

사용하였으며
,
복부


체를

Cranio
-
Caudal direction, 120Kvp, 150 Eff. MAs


1
-
breath hold


영상을

얻었다
.


Table feed


12mm/ 0.5sec


pitch 1
이었고
, Celiac artery
위치
(T12
-
L1
사이
)


Bolus T
racking
기법을

이용

역치



100


기준

하여

Artery phase Scan
delay


12sec, Portal


Artery phase


끝난



20 sec


각각

사용하였다
.


3. SCAN PARAMETER


1) Detector collimation: 0.75mm

2) Slice thick: 3mm, 5mm (Axial image)


0.75mm (MPR source image)

3) Reformat thickness : 3mm,
5mm

4) Feed / Rotation: 12mm( pitch:1)


5) Scan time: Abdomen ; 9sec
±
1.3sec ( 1 Scan range 20cm

24cm )


Abdomen+pelvis : 19sec
±
2.1sec(1 Scan range 40cm
-
50cm)


전체

상복부를

0.75 Collimation
으로

B31f medium smooth+ kernel
값을

이용하


recon
하였다
.
이렇게

C
T Scanner
로부터

얻어진

MDCT Data


Workstation


Leonardo


보내졌고

Slice thickness 3mm 5mm


전후
,
좌우
( Coronal, Sagital )
reformat
하였으며
, PACS


보내져

저장이

되었다
.









그림
4.
C
oronal Reformat 5mm image


8

329
328
327
317
1
351
360
380
397
1
383
391
363
385
1
365
376
368
383
1
366
379
454
467
1
263
266
268
267
1
349
361
373
376
1
391
390
381
368
1
326
340
323
337
1
298
298
273
273
1
407
411
410
424
394
417
350
374
1
413
414
412
385
377
380
376
365
1
406
414
404
412
406
402
417
426
2
415
403
419
421
428
434
438
443
2
415
401
419
389
303
306
302
297
2
418
403
412
419
328
338
320
291
1
418
415
419
425
307
302
313
291
1
403
403
413
396
331
361
343
357
2
410
414
410
425
327
333
356
296
1
407
409
419
428
431
427
442
406
1
corRm5,10

,ROI
corR3m,10

ROI
Ax5m,10

,ROI
Ax3m,10

,ROI
Cor5m
ReF
Cor3m
ReF
Ax5
mS
Ax3
mR


same image for ROI
각각
10

CorReF,image
Axial recon
image
동일환자
(1

)image ROI
환자별
ROI
329
328
327
317
1
351
360
380
397
1
383
391
363
385
1
365
376
368
383
1
366
379
454
467
1
263
266
268
267
1
349
361
373
376
1
391
390
381
368
1
326
340
323
337
1
298
298
273
273
1
407
411
410
424
394
417
350
374
1
413
414
412
385
377
380
376
365
1
406
414
404
412
406
402
417
426
2
415
403
419
421
428
434
438
443
2
415
401
419
389
303
306
302
297
2
418
403
412
419
328
338
320
291
1
418
415
419
425
307
302
313
291
1
403
403
413
396
331
361
343
357
2
410
414
410
425
327
333
356
296
1
407
409
419
428
431
427
442
406
1
corRm5,10

,ROI
corR3m,10

ROI
Ax5m,10

,ROI
Ax3m,10

,ROI
Cor5m
ReF
Cor3m
ReF
Ax5
mS
Ax3
mR


same image for ROI
각각
10

CorReF,image
Axial recon
image
동일환자
(1

)image ROI
환자별
ROI








그림
5. Sagital Reformat 5mm image


모든

Axial image, MPR image


같은

WW,W
L value (350, 40 )


soft tissue
window setting
으로

display
되었다
.




제의

증강정도와

Noise level


측정은

PACS image
에서

측정하였고
,
이는

Axial image


대한

MPR image


부가적인

진단가치

location, shape,
주위관계
, axial image


대한

도움정도

등을

알아보기

위해

20
명의
LIVER
환자
(

3) Image


무작위

축출하여

정량적으로

Axial


MPR
image


descending Aorta


ROI
값을

측정해서

Axial 3m, 5m, Coronal
Reformat 3m, 5m,
서로의

상관

관계를

알아

보았다




3. Liver
환자

ROI Data
수집

Axial, coronal 3mm, 5mm


image


가지고

각각

10

(

40

)

20
명의

환자별

ROI
측정



9

또한
,
측정오차

범위를

줄이기

위해



환자의

Axial, coronal 3mm, 5mm


image


가지고

각각

10

(

40

)
측정하여
(

5)
서로의

상관

관계를

구하여

보았다
.







Axial 3mm image Axial 5mm image









Coronal 3mm Reformat image Coronal 5mm Reformat image


그림

6. Axil


coronal reformat image


통계학적

분석은

MINITAB(GE 6 sigma


사용된

프로그램
)


사용하였고

image
quality


Organ


visualization


대한

비교수치는

계산평균값을

이용하여

비교하
였다
.


결과



환자마다

부피에

따라

다르지만

MDCT


이용하여

시행한

복부

SCAN


소요
되는

시간은

8
-
11

(1 phase), MPR reformat


필요한

source image


Axial
0.75mm

recon time

4min
정도였으며

이를

바탕으로

시행한

MPR
processing




환자마다

1min
정도

걸렸다
. Axial image & MP
R image quality


대한

ROI
값의

비교분석

하여

수치화

하였는데

단지

수치상으로



image quality


대한


이는

거의

없는

것으로

나타났다
. PACS monitor


Axial image
에서

arterial
Phase


ROI
평균값은

thickness 3mm


355.8, thickness 5mm


358.35
이었고

MPR image
에서는

thickness 3mm


359.45, thickness 5mm


352.65


나타났

.(


값의



3mm


3.55 , 5mm


5.70 )
또한

측정오차범위를

줄이기

위해



10

2
6
0
3
0
0
3
4
0
3
8
0
4
2
0
4
6
0
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
3
2
0
3
3
0
3
4
0
3
5
0
3
6
0
3
7
0
3
8
0
9
5
%

C
o
n
f
i
d
e
n
c
e

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n
t
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v
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l

f
o
r

M
e
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d
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l
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e
:
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v
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r
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9
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7
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0
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4
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7
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8
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0
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8
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0
.
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5
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.
5
0
0
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8
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.
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5
0
4
5
4
.
0
0
0
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8
2
.
8
9
2

7
6
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9
0
3
7
9
.
0
5
9
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n
d
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r
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o
n
-
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a
r
l
i
n
g

N
o
r
m
a
l
i
t
y

T
e
s
t
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

S
i
g
m
a
9
5
%

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o
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f
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c
e

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t
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r
v
a
l

f
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r

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t
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3
2
5
3
5
0
3
7
5
4
0
0
4
2
5
4
5
0
4
7
5
0
1
2
3
4
5
6
A
x
3
m
R
F
r
e
q
u
e
n
c
y
H
i
s
t
o
g
r
a
m

o
f

A
x
3
m
R
,

w
i
t
h

N
o
r
m
a
l

C
u
r
v
e




사람에서

측정한

ROI
측정치는

Axial image thickness 3mm


412.4
thickness 5mm


413.7
이었고
, MPR image thickness 3mm 408.7 thickness
5mm 411.2


나타났다
. (


값의



3mm


5.7 , 5mm


2.5 )













그림

7. Axial image RO
I
평균값

thickness 3mm


















그림

8. Axial image ROI
평균값

thickness 5mm





11

2
6
0
3
0
0
3
4
0
3
8
0
4
2
0
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
3
3
0
3
4
0
3
5
0
3
6
0
3
7
0
3
8
0
3
9
0
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
e
d
i
a
n
V
a
r
i
a
b
l
e
:

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o
r
3
m
R
e
F
A
-
S
q
u
a
r
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d
:
P
-
V
a
l
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e
:
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v
V
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r
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s
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i
n
i
m
u
m
1
s
t

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u
a
r
t
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l
e
M
e
d
i
a
n
3
r
d

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u
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t
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a
x
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8
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1
2
4

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4
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5
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3
3
4
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6
0
.
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7
3
0
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9
1
6
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5
9
.
4
5
0

4
5
.
5
6
6
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0
7
6
.
2
6
-
2
.
4
E
-
0
1
-
5
.
3
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-
0
1
2
0
2
6
6
.
0
0
0
3
2
9
.
2
5
0
3
6
1
.
0
0
0
3
9
0
.
7
5
0
4
3
4
.
0
0
0
3
8
0
.
7
7
6

6
6
.
5
5
2
3
8
7
.
6
4
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n
d
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n
-
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a
r
l
i
n
g

N
o
r
m
a
l
i
t
y

T
e
s
t
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
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r
v
a
l

f
o
r

M
u
9
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f
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e

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v
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l

f
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r

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l

f
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r

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t
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s
2
7
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0
3
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0
4
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9
5
%

C
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f
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l

f
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r

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u
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5
3
3
5
3
4
5
3
5
5
3
6
5
3
7
5
3
8
5
9
5
%

C
o
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f
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c
e

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n
t
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v
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l

f
o
r

M
e
d
i
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V
a
r
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R
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t

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u
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4
3

3
4
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1
3
5
3
2
7
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2
3
5
0
.
2
1
0
0
.
8
3
7
3
5
2
.
6
5
0

4
4
.
8
8
6
2
0
1
4
.
7
7
3
.
8
1
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-
0
2
-
5
.
1
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-
0
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2
0
2
6
3
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0
0
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2
6
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3
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7
3
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6
5
7

6
5
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5
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n
d
e
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n
-
D
a
r
l
i
n
g

N
o
r
m
a
l
i
t
y

T
e
s
t
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
u
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

S
i
g
m
a
9
5
%

C
o
n
f
i
d
e
n
c
e

I
n
t
e
r
v
a
l

f
o
r

M
e
d
i
a
n
D
e
s
c
r
i
p
t
i
v
e

S
t
a
t
i
s
t
i
c
s













그림

9. MPR image thickness 3mm ROI















그림

10. MPR image thickness 5mm ROI


장기를

관찰하는데

있어서

Axial
단독

그리고

Axial + MPR
사이에

수치상으로


타난

바에

의하면



차이가

없어


이지만
(

10

Ax
ial
3m
m
R
eformat

ROI

C潲
潮慬


Ref潲m慴

ROI


ANOVA(
분산분석
)
전체적
Anatomy structure





평가는

MPR
에서

더욱



보였다
.






12


4.

Ax3mR
ROI

C潲㍭3敆

ROI


ANOVA(
분산분석
)


One
-
way ANOVA: Ax
ial
3m
m
R
eformat

versus Cor
onal
3
m
m

Reformat


Analysis of Variance

for Ax3mR

Source DF SS MS F
P

Cor3mReF 18 63533 3530 19.55
0.176

Error 1 181 181

Total 19 63713

95%
신뢰구간에서

P
값이

0.05
보다

큼으로

Axial 3m


Coronal Reformat 3mm


ROI



차이가

없다
.

Individ
ual 95% CIs For Mean


Based on Pooled St

Dev

Level N Mean St

Dev
----
+
---------
+
---------
+
---------
+
--

266 1 267.00 0.00 (
-----------
*
----------
)

298 1 273.00 0.00 (
-----
-----
*
-----------
)

302 1 291.00 0.00 (
----------
*
-----------
)

306 1 297.00 0.00 (
-----------
*
----------
)

328 1 317.00 0.00 (
----------
*
-----------
)

333 1 296.00 0.00 (
-------
----
*
----------
)

338 1 291.00 0.00 (
----------
*
-----------
)

340 1 337.00 0.00 (
----------
*
-----------
)

360 1 397.00 0.00 (
----------
*
-----------
)

361 2 366.50 13.44

(
-------
*
-------
)

376 1 383.00 0.00 (
-----------
*
----------
)

379 1 467.00 0.00 (
----------
*
-----------
)

380 1 365.00 0.00 (
----------
*
-----------
)

390 1 36
8.00 0.00 (
-----------
*
----------
)

391 1 385.00 0.00 (
-----------
*
----------
)

402 1 426.00 0.00 (
----------
*
-----------
)

417 1 374.00 0.00 (
----------
*
----------
)


427 1 406.00 0.00 (
----------
*
----------
)

434 1 443.00 0.00 (
-----------
*
----------
)


----
+
---------
+
---------
+
---------
+
--

Pooled St

Dev = 13.44
150 300 450 600




13

특히

Liver surface segment lesion
부위의

관찰에

있어

뛰어난

것으로

드러났다
.
또한

MDCT


이용하여

Pancreas


display
하는

능력은

대단히

증가되었다
.
이는

최적의





증강으로

Pancreas


전체적

윤곽



중요

부위를

아주

분명하게





있게

되었다는

의미를

갖는다
.

Axial image


추가적인

유용한

정보를

제공하는

MPR image


부가적인

진단가치


대한

이해는

그림

에서와

같이

tumor thrombus


혈관

침범정도가

Axial
보다

MPR
에서

훨씬





보여질



있다는

것을



보여준다
.

3mm, Axial image 3mm, Coronal MPR image

5mm, Axial image 5mm, Coronal MPR image


그림
11. Liver


axial


Coronal reformat image


또한

MPR


그림에서

보이는

것처럼

Aorta


직경
,
주행경로
,
그리고

SMA





Aorta


branch
또한

더욱



쉽고

용이하게





있고
(
그림
a, b, c)
의심스러


아주

작은

병소도



보여준다
.
이러한

예에서

보여주는

것처럼

MPR


우리가

복잡한

Anatomy


병소부위를

관찰하고

자신감

있게

진단할



있도록

다양하게

도와준다
.


14


(a) (b)

(c)


그림

12. Aorta

SMA


MPR
영상

따라서
,
이제까지

제한적으로

시행해오던

MPR Reformat


Axial image


더불어

Routine






있었고

이는

환자의

Position
이동

없이

여러

방향의

scan




것과

같은

동일

image


얻을



있었다
.


고찰

16 channel MDCT


이용한

scan time


Data recon
속도는

기존의

4 channel
MDCT


비교하여





전체적인

촬영범
위는

같을



있지만

촬영시간
, image
quality


recon time


있어

월등히

향상된

성능을

보임으로써

커다란

anatomical
area,


Abdomen or Pelvis


있어

motion artifact
없는

사실적인

image


얻을



있다
. MPR


복잡한

병리학적인

정보를

교환하고

display
하는

아주

강력한

Tool
이다
.
양질의

MPR image


얻기

위해서는

아주

좋은

Z
-


resolution





것이

필수적이다
.
최근

16channel MDCT


개발로

real time Multi
-
Plane
Reconstruction


가능해졌으며
,
기존의

axial image


MPR


coronal, sagittal
reformat
으로

Abdomen pelvis


CT
촬영에



한층

넓은

진단영역을

제공하여




부위의

평가에

커다란

도움을

주었다
.

따라서

기존의

axial image
뿐만

아니라

MPR image


다양한

reformat


통한

정확한

환자의

진단을





있으리라

보며
,
다른

분야에

있어서도

유용한

정보가

되리라

믿는다
.



가지

아쉬운

점은

현재

본원

PACS


HU
값의

표현을





없고
,
표현되는

ROI
값은

pixel value
값의

변환

이어서
, PACS
상의

image


CT date


직접비교를





없었던

점이며

Liver


기타

다른

조직의

병소

부위에

ROI
값을

측정하여


교하지

못했다는

점과
, MPR source image
개수가

너무

많아

보관이

용이하지

못하

15

다는



등이었다
.

으로

좀더

노력

해봐야



것은
, collimation


변화와
, pitch


변화에

따른

axial


MPR


상관

관계를

구분해

보는

것이라

생각된다
.


참고문헌


1.

Kenneth Wong.MD
Erik

K. Paulson.MD Rendon C. Nelson, MD

: Breath
-
hold Three
-
dimensional CT of the Liver with Multi
-
Detector Row
Helical CT , Radiology 2001; 219:7
5
-
79


2.

Cheng Hong , Roland Bruening , Uwe J . Schoepf , Kyongtae T. Bae

: Multiplanar reformat display technique in abdominal multi
-
detector row

CT imaging ,; Journal of Clinical Imaging 27(2003) 119
-
123



3.

Hu H, He HD, Foley WD, Fox SH. Four;

: multi
-
de
tector row helical CT ;image quality and volume coverage speed.


Radiology 2000;215:55
-
62



4.

SOMATOM Sensation 16 Application Guide(Software Version A60)


5.

M. F. Reiser, M. Takahashi, M. Modic, R. Bruening ; Multislice CT;


MEDICAL RADIOLOGY Dia
gnostic Imaging ,Springer, 2001.2002:

23
-
33


6.
대한전산화단층기술학회지
; 2002.4