Videlefsky N, Parks W J, Oshinski J, Hopkins K L, Sullivan K M, Pettigrew R I, Fyfe D
Pediatric Cardiology Association, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2001 Jul;38(1):262-7. doi: 10.1016/s0735-1097(01)01338-9.
This study evaluated the accuracy, advantages and clinical efficacy of magnetic resonance (MR) phase-shift velocity mapping, in delineating the site and the hemodynamic severity of pulmonary venous (PV) obstruction in patients with congenital heart disease (CHD).
Magnetic resonance phase-shift velocity mapping of normal pulmonary veins and of obstructed PV pathways have been previously reported in a mainly adult population.
The study population (33 pts) underwent MR phase-shift velocity mapping of their PV pathways. These results were compared with cardiac catheterization and Doppler echocardiography data.
The study population (0.4 to 19.5 years) consisted of a study group (PV pathway obstruction, n = 7) and a control group (no PV obstruction, n = 26). No patients had any left-to-right shunt lesions. The MR imaging displayed precise anatomical detail of the pulmonary veins. Phase velocities in the control group ranged from 20 to 71 cm/s, whereas velocities in the study group ranged from 100 to 250 cm/s (p = 0.002). The MR phase velocities (154 +/- 0.53 cm/s) compared favorably with Doppler echocardiography (147 +/- 0.54 cm/s), (r = 0.76; p = 0.05). The MR velocity mapping was 100% specific and 100% sensitive in detecting PV obstruction, although the absolute gradient measurements among MR phase mapping, echocardiographic Doppler and catheterization did not show statistically significant correlation.
In the absence of any associated left-to-right shunt lesions, PV velocities of 100 cm/s and greater indicated significant obstruction. The MR phase-shift velocity mapping, together with MR spin echocardiography and MR angiography, provides comprehensive anatomic and physiologic data that may obviate the need for further invasive studies.
本研究评估了磁共振（MR）相移速度成像在确定先天性心脏病（CHD）患者肺静脉（PV）梗阻部位及血流动力学严重程度方面的准确性、优势和临床疗效。
此前主要在成年人群中报道过正常肺静脉和梗阻性PV通路的磁共振相移速度成像。
研究人群（33例患者）接受了PV通路的MR相移速度成像检查。将这些结果与心导管检查和多普勒超声心动图数据进行比较。
研究人群年龄在0.4至19.5岁之间，包括一个研究组（PV通路梗阻，n = 7）和一个对照组（无PV梗阻，n = 26）。所有患者均无左向右分流病变。MR成像显示了肺静脉精确的解剖细节。对照组的相速度范围为20至71 cm/s，而研究组的速度范围为100至250 cm/s（p = 0.002）。MR相速度（154±0.53 cm/s）与多普勒超声心动图（147±0.54 cm/s）相比具有优势，（r = 0.76；p = 0.05）。MR速度成像在检测PV梗阻方面特异性为100%，敏感性为100%，尽管MR相位成像、超声心动图多普勒和心导管检查之间的绝对梯度测量结果无统计学显著相关性。
在无任何相关左向右分流病变的情况下，PV速度≥100 cm/s表明存在明显梗阻。MR相移速度成像与MR自旋回波心动图和MR血管造影一起，可提供全面的解剖和生理数据，可能无需进一步的侵入性检查。
