목 적：MRCP검사시 CS SPACE breath-hold기법을 사용하여 조영전과 Gd-EOB- DTPA 사용후 영상을 시간대별로 획 득하여 영상의 변화를 통해 담즙의 변화를 알아보고, 이를 바탕으로 3D T2강조 자기공명 담췌관 조영영상의 적절한 획득시기를 알아보고자 하였다.
대상 및 방법：2017년 11월부터 2018년 1월까지 본원에 내원하여 Gd-EOB-DTPA를 사용하여 MRCP검사를 시행한 42 명을 대상으로 하였고 장비는 SIEMENS사의 Magnetom Skyra 3.0T를 사용하였다. Compressed Sensing SPACE breath-hold 기법으로 조영전과 Gd-EOB-DTPA를 사용한 역동적 조영검사 후 delay 4m, 6m, 8m 때의 3D T2강조 자기공명 담췌관 조영영상을 MIP기법을 사용하여 영상을 재구성한 뒤, RHD, LHD, CBD의 SNR과 CNR을 측정하였고, 정성적 평가는 조영전과 Gd-EOB-DTPA사용후 delay 4m, 6m, 8m때의 RHD, LHD, CBD를 복부전문 영상의학과 전문의 1명과 10년 이상 경력의 MRI전문 방사선사 1명이 5점 척도로 평가하였다.
결 과：조영전 RHD, LHD, CBD의 평균 SNR은 33.07, 32.18, 38.43 였고, Gd-EOB-DTPA사용후 delay 4m때의 평균 SNR은 38.1, 36.33, 43.16, delay 6m때는 37.79, 37.67, 44.46, delay 8m때는 30.24, 35.29, 41.45였다. CNR은 조영전이 평균 22.27, 21.36, 27.59, Gd-EOB-DTPA사용후 delay 4m때는 27.1, 25.32, 32.12, delay 6m때는 26.81, 26.71, 33.41, delay 8m때는 19.14, 24.21, 30.28 였다. delay 8m때의 RHD의 SNR과 CNR만 조영전과 비교해서 통계 적으로 유의하지 않았으며(p>0.05) 나머지는 통계적으로 유의했다(p<0.05). SNR과 CNR이 조영전부터 delay 8m때까지 순차적으로 계속 증가하는 경우는 전체의 47.6%였고, 조영전보다 delay 6m때의 SNR과 CNR이 더 높지만 delay 8m때 감소하는 경우가 전체의 40.5%, 조영전보다 delay 4m때의 SNR과 CNR이 더 높지만 delay 6m, 8m때 감소하는 경우는 전체의 11.9%였다. 정성적 평가는 조영전 RHD, LHD, CBD의 평균점수가 4.48, 4.55, 4.93였고, Gd-EOB-DTPA사용 후 delay 4m때는 4.48, 4.55, 4.86, delay 6m때는 4.12, 4.5, 4.88, delay 8m때는 3.55, 4.1, 4.64 였다. 조영전과 delay 4m은 통계적으로 유의한 차이가 없었고(p<0.05), 조영전과 delay 6m은 RHD만, 조영전과 delay 8m은 RHD, LHD 가 통계적으로 유의한 차이가 있었다(p>0.05).
결 론：조영전과 Gd-EOB-DTPA사용후 delay 4m때의 영상의 진단적 차이가 없었으며, delay 4m때가 SNR과 CNR이 더 높았기 때문에 delay 4m때 breath-hold 3D T2강조 자기공명 담췌관 조영영상을 얻는것이 검사시간도 단축하고 더 좋은 영상을 얻을 수 있을겄으로 생각되며, 담췌관에 질병이 의심되는 환자에서 respiratory-triggered 3D T2강조 자기공 명 담췌관 조영영상은 역동적 조영검사 후에 바로 시행하여 delay 6m전에 검사를 획득한다면 담도배설이 시작되기 전에 영상을 획득하거나 담도배설이 어느정도 시작되었어도 높은 신호때부터 영상이 얻어졌기 때문에 조영전과 영상의 차이가 없고 시간을 많이 단축하는 방법이 될거라 생각된다.

Pulpose：Using the compressed sensing SPACE technique during MRCP, we obtained images of the precontrast and postcontrast by time interval and found changes in the bile through the image change. Based on this, we wanted to know the optimal acqusition time of 3D T2-weighted MR cholangiopancreatographic image. Materials and Methods：From November 2017 to January 2018, 42 patients who visited our hospital and performed MRCP using Gd-EOB-DTPA were targeted. The MR system used Magnetom Skyra 3.0T(Siemens, Germany). 3D T2-weighted MR cholangiopancreatographic image was acquired at precontrast and postcontrast 4min, 6min, 8min after dynamic MR imaging using Gd-EOB-DTPA with Compressed Sensing SPACE breath-hold technique. After reconstructing this image with a MIP technique, we measured SNR and CNR of RHD, LHD, and CBD. Qualitative assessment was evaluated on a 5 score scale by one of the abdominal specialized radiologist and radiologictechnologist experienced 10 years in MRI. Results：The average SNR of precontrast RHD, LHD, CBD were 33.07, 32.18, 38.43 and post delay 4 min were 38.1, 36.33, 43.16, post delay 6 min were 37.79, 37.67, 44.46, post delay 8 min were 30.24, 35.29, 41.45 after using Gd-EOB-DTPA. The average CNR of precontrast RHD, LHD, CBD were 22.27, 21.36, 27.59 and post delay 4 min were 27.1, 25.32, 32.12, post delay 6 min were 26.81, 26.71, 33.41, post delay 8 min were 19.14, 24.21, 30.28 after using Gd-EOB-DTPA. Compared with the precontrast, there was not statistically significant in SNR, CNR of RHD at 8 min (p>0.05) and there was statistically significant in the rest (p<0.05). SNR and CNR continuously increased from precontrast to post delay 8 min was 47.6 % of the total, SNR and CNR were higher at post 6 min than precontrast but decreased at post delay 8 min was 40.5 % of the total, SNR and CNR were higher at post 4 min than precontrast but decreased at post delay 6 min, 8 min was 11.9 % of the total. Qualitative assessment showed that the average scores of precontrast RHD, LHD, CBD were 4.48, 4.55, 4.93, post delay 4 min were 4.48, 4.55, 4.86, post delay 6 min were 4.12, 4.5, 4.88, post delay 8 min were 3.55, 4.1, 4.64 after using Gd-EOB-DTPA. Compared with the precontrast, there was no statistically significant difference in 4 min (p<0.05), there was statistically significant difference in RHD of post delay 6 min and RHD, LHD of post delay 8 min (p>0.05). Conclusion：Because there was no diagnostic difference between precontrast and post delay 4 min using Gd-EOB-DTPA, and SNR, CNR at post delay 4 min was higher than precontrast, obtaining 3D T2-weighted MR cholangiopancreatographic image in 4 min could shorten the examination time and make better images. If triggered 3D T2-weighted MR cholangiopancreatographic image is performed immediately after dynamic MR imaging and it is obtained 6 min before in patients suspected of pancreaticobiliary disease, it will be a way to shorten the time without any difference from precontrast, because it was obtained before the biliary excretion begins or it was obtained from the high signal.

Ⅰ. 서 론
 Ⅱ. 대상 및 방법
  1. 기간 및 대상
  2. 연구장비
  3. 영상의 획득 및 Scan parameters
  4. 영상의 평가방법
 Ⅲ. 결 과
 Ⅳ. 고찰 및 결론
 References

• 이득열(전북대학교병원 영상의학과) | Deuk-Yeol Lee (Department of Radiology, Chonbuk National University Hospital) Corresponding Author
• 김은성(전북대학교병원 영상의학과) | Eun-Sung Kim (Department of Radiology, Chonbuk National University Hospital)
• 곽영곤(전북대학교병원 영상의학과) | Yeong-Gon Kwak (Department of Radiology, Chonbuk National University Hospital)
• 유영은(전북대학교병원 영상의학과) | Yeong-Eun Yu (Department of Radiology, Chonbuk National University Hospital)
• 이현근(전북대학교병원 영상의학과) | Hyun-Keun Lee (Department of Radiology, Chonbuk National University Hospital)
• 이광원(전북대학교병원 영상의학과) | Kwang-Won Lee (Department of Radiology, Chonbuk National University Hospital)