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1.  Planimetric Measurement of the Regurgitant Orifice Area Using Multidetector CT for Aortic Regurgitation: a Comparison with the Use of Echocardiography 
Korean Journal of Radiology  2010;11(2):169-177.
This study compared the area of the regurgitant orifice, as measured by the use of multidetector-row CT (MDCT), with the severity of aortic regurgitation (AR) as determined by the use of echocardiography for AR.
Materials and Methods
In this study, 45 AR patients underwent electrocardiography-gated 40-slice or 64-slice MDCT and transthoracic or transesophageal echocardiography. We reconstructed CT data sets during mid-systolic to enddiastolic phases in 10% steps (20% and 35-95% of the R-R interval), planimetrically measuring the abnormally opened aortic valve area during diastole on CT reformatted images and comparing the area of the aortic regurgitant orifice (ARO) so measured with the severity of AR, as determined by echocardiography.
In the 14 patients found to have mild AR, the ARO area was 0.18±0.13 cm2 (range, 0.04-0.54 cm2). In the 15 moderate AR patients, the ARO area was 0.36 ± 0.23 cm2 (range, 0.09-0.81 cm2). In the 16 severe AR patients, the ARO area was 1.00 ± 0.51 cm2 (range, 0.23-1.84 cm2). Receiver-operator characteristic curve analysis determined a sensitivity of 85% and a specificity of 82%, for a cutoff of 0.47 cm2, to distinguish severe AR from less than severe AR with the use of CT (area under the curve = 0.91; 95% confidence interval, 0.84-1.00; p < 0.001).
Planimetric measurement of the ARO area using MDCT is useful for the quantitative evaluation of the severity of aortic regurgitation.
PMCID: PMC2827780  PMID: 20191064
Computed tomography (CT); Echocardiography; Aortic regurgitation; Planimetry
2.  Multidetector CT and MR Imaging of Cardiac Tumors 
Korean Journal of Radiology  2009;10(2):164-175.
The purpose of this article is to provide a current review of the spectrum of multidetector CT (MDCT) and MRI findings for a variety of cardiac neoplasms. In the diagnosis of cardiac tumors, the use of MDCT and MRI can help differentiate benign from malignant masses. Especially, the use of MDCT is advantageous in providing anatomical information and MRI is useful for tissue characterization of cardiac masses. Knowledge of the characteristic MRI findings of benign cardiac tumors or thrombi can be helpful to avoid unnecessary surgical procedures. Presurgical assessment of malignant cardiac tumors with the use of MDCT and MRI may allow determination of the resectability of tumors and planning for the reconstruction of cardiac chambers.
PMCID: PMC2651440  PMID: 19270863
Cardiac tumor; Magnetic resonance (MR); Multidetector CT
3.  Usefulness of Multidetector-row CT in the Evaluation of Reperfused Myocardial Infarction in a Rabbit Model 
Korean Journal of Radiology  2004;5(1):19-24.
To evaluate the usefulness of multidetector-row computed tomography (CT) in the evaluation of reperfused myocardial infarction.
Materials and Methods
Eleven rabbits were subjected to 90-min occlusion of the left anterior descending coronary artery followed by reperfusion. Multidetector-row CT was performed 31 hours ± 21 after the procedure and pre- and post-contrast multiphase helical CT images were obtained up to 10 min after contrast injection. The animals were sacrificed after 30 days and histochemical staining of the resected specimens was perfomed with 2'3'5-triphenyl tetrazolium chloride (TTC).
In all 11 cases, the areas of myocardial infarction demonstrated with TTC-staining were identified on the CT images and the lesions showed hypoenhancement on the early phases up to 62 sec and hyperenhancement on the delayed phases of 5 min and 10 min compared with normal myocardial enhancement. The percentage area of the lesion with respect to the left ventricle wall on CT was significantly correlated with that of the TTC-staining results (p < 0.001 for both early and delayed phase CT) according to the generalized linear model analysis. The areas showing hypoenhancement on early CT were significantly smaller than those with hyperenhancement on delayed CT (p < 0.0001).
Multidetector-row CT may be useful in the detection and sizing of reperfused myocardial infarction.
PMCID: PMC2698109  PMID: 15064555
Animals; Computed tomography (CT), multidetector-row; Computed tomography (CT), helical technology; Myocardium, infarction; Myocardium, CT; Heart, CT
4.  MR Imaging of Congenital Heart Diseases in Adolescents and Adults 
Korean Journal of Radiology  2001;2(3):121-131.
Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of te ralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.
PMCID: PMC2718109  PMID: 11752982
Heart, MR; Heart, diseases; Heart, congenital anomalies
5.  Image quality and attenuation values of multi detector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 370 and iomeprol 400 
Background: Effects of high iodine-concentration contrast material on the image quality of coronary CT angiography (CCTA) have not been well evaluated.
Purpose: To compare the image quality and attenuation values of CCTA between patients administered iopromide 370 and iomeprol 400 with the use of 64-slice multidetector CT. Material and Methods: Patients were prospectively enrolled and were randomized into two groups (group A, 151 patients received iopromide 370, iodine flux = 1.48 g I/s; group B, 146 patients received iomeprol 400, iodine flux = 1.60 g I/s). CT attenuation was measured in the coronary arteries and great arteries and measurements were standardized based on an iodine flux of 1.5 0 g I/s. The image quality of 15 coronary artery segments was graded by two radiologists in consensus with the use of a four-point scale (1 = excellent to 4 = poor enhancement). Non-parametric statistical approaches were used to compare the two groups.
Results: The median attenuation values in the coronary arteries were 454 HU and 464 HU for iopromide 370 and iomeprol 400, respectively, and they did not differ (P = 0.26). When standardizing for an iodine flux, significantly higher attenuation values were found for iopromide 370 (median = 460 HU, range = 216-791 HU) compared with iomeprol 400 (median = 435 HU, range = 195—758 HU) (P = 0.006). The median image quality score of coronary arterial segments was 1 (range 1—2) for both groups (P = 0.84).
Conclusion: The attenuation values in the coronary arteries after injection of the same amount of two high iodine-concentration contrast materials at the same flow rate with different iodine fluxes are similar with no difference in image quality. With standardization for an iodine flux, the attenuation is significantly higher when using iopromide 370.
PMCID: PMC2981075  PMID: 20849317
Coronary arteries; CT angiography; contrast agent
8.  Understanding of chest pain in microvascular disease proved by cardiac magnetic resonance image (UMPIRE): study protocol for a randomized controlled trial 
Trials  2014;15(1):333.
Microvascular angina (MVA) is characterized by anginal chest pain, an abnormal stress test, and normal coronary arteries on coronary angiography. Although the exact pathogenesis remains unclear, endothelial dysfunction is a contributing factor. To date, there exists no specific therapy for this disease. Phosphodiesterase-5 inhibitor improves the endothelial function and subsequently microvascular circulation. The aim of this study is to identify whether udenafil offers benefits in the treatment of MVA in female patients, who have a perfusion defect in their cardiac magnetic resonance image (CMR), but normal coronary arteries.
The ‘Understanding of Chest Pain in Microvascular Disease Proved by Cardiac Magnetic Resonance Image: (UMPIRE)’ trial is a multicenter, prospective, randomized, placebo controlled trial, designed to evaluate the effect of udenafil on myocardial ischemia and symptoms in female patients with MVA. The myocardial ischemia will be quantified by myocardial stress perfusion defect in CMR. A total of 80 patients with proven perfusion defect in adenosine-stress CMR will be randomly assigned to either the udenafil treatment group (daily dose of 100 mg) or the placebo group for three months. The primary endpoint is >25% improvement in perfusion defect size in adenosine-stress CMR from baseline. The secondary endpoints include <25% improvement in perfusion defect size, chest pain frequency, ST depression in stress test, Duke score in stress test, quality of life (QoL) assessment by SF-36 questionnaire, sexual dysfunction assessment by BISF-W (Brief Index of Sexual Functioning for Women) self-assessment questionnaire, and biomarkers for endothelial function.
The UMPIRE trial is the first randomized controlled trial to evaluate the efficacy of udenafil in female MVA patients. If udenafil demonstrates cardioprotective effects, it may provide a novel therapeutic option to reduce myocardial ischemia and improve cardiac function in female MVA patients.
Trial registration
Clinical NCT01769482 (registered on 20 November 2012).
PMCID: PMC4155115  PMID: 25154607
Microvascular angina; PDE-5 inhibitors; Cardiac MRI
9.  Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation 
Korean Circulation Journal  2014;44(3):170-176.
Background and Objectives
Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation.
Subjects and Methods
Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month.
Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction.
We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.
PMCID: PMC4037639  PMID: 24876858
Vascular surgical procedure; Coronary artery disease; Multidetector computed tomography; Myocardial perfusion imaging
15.  Early detection of subclinical ventricular deterioration in aortic stenosis with cardiovascular magnetic resonance and echocardiography 
Severe aortic stenosis (AS) patients with late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) or left ventricular (LV) systolic dysfunction are known to have worse outcome. We aimed to investigate whether LGE on CMR would be useful in early detection of subclinical LV structural and functional derangements in AS patients.
118 patients with moderate to severe AS were prospectively enrolled. Echocardiography and CMR images were taken and the patients were divided into groups according to the presence/absence of LGE and of LV systolic dysfunction (LV ejection fraction (EF) <50%). The stiffness of LV was calculated based on Doppler and CMR measurements.
Patients were grouped into either group 1, no LGE and normal LVEF, group 2, LGE but normal LVEF and group 3, LGE with depressed LVEF. There was a significant trend towards increasing LV volumes, worsening of LV diastolic function (E/e’, diastolic elastance), systolic function (end-systolic elastance) and LV hypertrophy between the three groups, which coincided with worsening functional capacity (all p-value < 0.001 for trend). Also, significant differences in the above parameters were noted between group 1 and 2 (E/e’, 14.6 ± 4.3 (mean ± standard deviation) in group 1 vs. 18.2 ± 9.4 in group 2; end-systolic elastance, 3.24 ± 2.31 in group 1 vs. 2.38 ± 1.16 in group 2, all p-value < 0.05). The amount of myocardial fibrosis on CMR correlated with parameters of diastolic (diastolic elastance, Spearman’s ρ = 0.256, p-value = 0.005) and systolic function (end-systolic elastance, Spearman’s ρ = -0.359, p-value < 0.001).
These findings demonstrate the usefulness of CMR for early detection of subclinical LV structural and functional deterioration in AS patients.
PMCID: PMC3766067  PMID: 23984681
Aortic stenosis; Cardiovascular magnetic resonance; Echocardiography; Heart function; Ventricular remodeling; Magnetic resonance imaging; Myocardial function; Myocardial fibrosis
17.  Acute Recurrent Pericarditis Accompanied by Graves' Disease 
Korean Circulation Journal  2012;42(6):419-422.
The etiology of acute pericarditis is often thought to be autoimmune, and Graves' disease has been reported in a few series to manifest as acute pericarditis. Since the etiology of recurrent pericarditis is known to be more associated with autoimmune causes, recurrent acute pericarditis may be a potential cardiovascular complication of Graves' disease. We report a case of recurrent acute pericarditis that was presumed to be associated with Graves' disease which was controlled after management of the problem of the thyroid.
PMCID: PMC3390428  PMID: 22787473
Pericarditis; Graves disease
18.  A Newly Developed Pericardial Tuberculoma During Antituberculous Therapy 
Korean Circulation Journal  2011;41(12):750-753.
Tuberculosis generally affects the respiratory tract. In developing nations, the pericardium is the most common location of extrapulmonary tuberculosis; however, tuberculous pericarditis rarely appears as a localized mass or tuberculoma. We present here a case of a 62-year-old woman with pericardial tuberculoma. She had a history of effusive tuberculous pericarditis and drainage. Because she had taken regular medication over a period of six months, the pericardial mass with an adjacent lung nodule newly detected on the chest radiogram was initially suspected of being invasive lung cancer. Prior to pathologic confirmation, precise information from imaging tests, including computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography are helpful when making decisions regarding which methods should be used for surgical approach and treatment. Through imaging, our case showed typical features of pericardial tuberculoma and a favorable clinical course after two months with a change in antituberculous therapy.
PMCID: PMC3257460  PMID: 22259607
Tuberculosis; Magnetic resonance imaging
19.  Early Non-Invasive Diagnosis and Treatment of Acute Eosinophlic Myopericarditis by Cardiac Magnetic Resonance 
Journal of Korean Medical Science  2011;26(11):1522-1526.
We report a case of early non-invasive diagnosis of acute eosinophilic myopericarditis (AEM) by cardiovascular magnetic resonance (CMR) before cardiac biopsy. A 35-yr-old woman presented with a flu-like illness, followed by pleuritic chest pain and shortness of breath. Transthoracic echocardiography revealed mild left ventricular (LV) systolic dysfunction with borderline LV wall thickness and moderate pericardial effusion. The patient had peripheral eosinophilia and CMR was performed immediately at first day of visit before cardiac biopsy. CMR showed diffuse subepicardial high T2 signals and diffuse late gadolinium enhancement in LV. Steroid therapy was immediately initiated and patient's symptom was rapidly improved. Endomyocardial biopsy at hospital day 3 reported multifocal mild infiltration of eosinophils and lymphocytes. The patient was finally confirmed as acute eosinophilic myopericarditis. This presentation emphasizes on the role of CMR which enables early non-invasive diagnosis of AEM and visualize the extent of the myocarditis.
PMCID: PMC3207060  PMID: 22065913
Myocarditis; Magnetic Resonance Imaging
20.  A Huge Mediastinal Organizing Hematoma Causing Reversal of Atrial Septal Defect Shunt Flow 
Korean Circulation Journal  2011;41(2):97-100.
We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5×8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.
PMCID: PMC3053567  PMID: 21430995
Mediastinal cyst; Atrial septal defect; Hematoma
21.  Early detection of cardiac involvement in Miyoshi myopathy: 2D strain echocardiography and late gadolinium enhancement cardiovascular magnetic resonance 
Miyoshi myopathy (MM) is an autosomal recessive distal myopathy characterized by early adult onset. Cardiomyopathy is a major clinical manifestation in other muscular dystrophies and an important prognostic factor. Although dysferlin is highly expressed in cardiac muscle, the effect of dysferlin deficiency in cardiac muscle has not been studied. We hypothesized that early myocardial dysfunction could be detected by 2D strain echocardiography and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR).
Five consecutive MM patients (3 male) in whom we detected the DYSF gene mutation and age-matched healthy control subjects were included. None of the patients had history of cardiac disease or signs and symptoms of overt heart failure. Patients were studied using 2D strain echocardiography and CMR, with 2D strain being obtained using the Automated Function Imaging technique.
All patients had preserved left ventricular systolic function. However, segmental Peak Systolic Longitudinal Strain (PSLS) was decreased in 3 patients. Global PSLS was significantly lower in patients with MM than in control subjects (p = 0.005). Basal anterior septum, basal inferior septum, mid anterior, and mid inferior septum PSLS were significantly lower in patients with MM than in control subjects (P < 0.0001, < 0.0001, 0.038 and 0.003, respectively). Four patients showed fibrosis by LGE. The reduced PSLS lesion detected by 2D strain tended to be in the same area as that which showed fibrosis by LGE.
Patients with MM showed subclinical involvement of the heart. 2D strain and LGE are sensitive methods for detecting myocardial dysfunction prior to the development of cardiovascular symptoms. The prognostic significance of these findings warrants further longitudinal follow-up.
PMCID: PMC2887439  PMID: 20497525
22.  Endocardial Fibroelastosis in a 57-Year-Old Transplant Recipient 
Korean Circulation Journal  2010;40(4):204-207.
Endocardial fibroelastosis (EFE) is characterized by deposition of collagen and elastin leading to ventricular hypertrophy and diffuse endocardial thickening. Here we report (for the first time in Korea) the case of a EFE presenting with heart failure. The patient was a 57-year-old woman who had complained of dyspnea on exertion {New York Heart Association (NYHA) functional class 3} and abdominal distension at the time of hospital admission. Echocardiography showed severe diastolic dysfunction with normal systolic function. On MRI, the contrast-enhanced delayed myocardial image demonstrated hyperenhancement in the endocardium. Owing to progressive heart failure, the patient was transplanted. Histological examination of the explanted heart showed irregularly thickened endocardium with fibrosis and elastosis in the both ventricles, compatible with the diagnosis of EFE.
PMCID: PMC2859340  PMID: 20421963
Endocardial fibroelastosis; Cardiomyopathy, restrictive; Cardiac transplantation
23.  Flash Pulmonary Edema in a Patient With Unilateral Renal Artery Stenosis and Bilateral Functioning Kidneys 
Korean Circulation Journal  2010;40(1):42-45.
Flash pulmonary edema typically exhibits sudden onset and resolves rapidly. It generally is associated with bilateral renal artery stenosis or unilateral stenosis in conjunction with a single functional kidney. We describe a patient who presented with flash pulmonary edema treated by percutaneous therapy with stent implantation. Our case is unique in that the flash pulmonary edema occurred in the setting of unilateral renal artery stenosis with bilateral functioning kidneys.
PMCID: PMC2812797  PMID: 20111652
Pulmonary edema; Renal artery obstruction; Stents
24.  Percutaneous Transluminal Angioplasty of Renal Artery Fibromuscular Dysplasia: Mid-term Results 
Korean Journal of Radiology  2008;9(1):38-44.
To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD).
Materials and Methods
Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated.
The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.
Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.
PMCID: PMC2627178  PMID: 18253074
Percutaneous transluminal renal artery angioplasty; Fibromuscular dysplasia; Renal artery stenosis, angioplasty; Renovascular hypertension
25.  Targeted Ultrasound for MR-Detected Lesions in Breast Cancer Patients 
Korean Journal of Radiology  2007;8(6):475-483.
To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US.
Materials and Methods
One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.
Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.
Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.
PMCID: PMC2627449  PMID: 18071277
Breast cancer; Magnetic resonance (MR); Ultrasound (US)

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