Rominger M B, Kluge A, Dinkel H-P, Bachmann G F
Abteilung Strahlendiagnostik, Philipps-Universität Marburg, Germany.
Rofo. 2002 Nov;174(11):1380-6. doi: 10.1055/s-2002-35336.
Comparison between biventricular volumetric measurements and flow measurements in ascending aorta (Ao) and pulmonary outflow tract (Pu) for quantification of intracardial shunts, and evaluation of the combination of biventricular cine MRI with flow measurements for the assessment of RV and LV heart failure and valvular regurgitation (VR).
In 24 patients, right (RV) and left (LV) ventricular volumetric and flow measurements were performed in the Ao and Pu to assess the ratio of RV stroke volume (SV) or, respectively, pulmonary SV to LV SV or, respectively, systemic aortic SV (Qp/Qs). 34 patients without echocardiographically proven shunt or VR served as control group for measurement accuracy. Left-to-right shunt ratios were calculated from RV and LV SV, Pu and Ao SV, Pu and LV SV, and RV and Ao SV. Left ventricular VR was calculated by the difference of LV SV and Ao SV, and right ventricular VR by the difference of RV SV and Pu SV. Global systolic function was evaluated by biventricular cine MRI.
Intracardial shunts with Qp/Qs > 1.16 can be quantified by flow measurements in Ao and Pu. Using biventricular volumetric measurements in cases without VR, requires a Qp/Qs > 1.21. 17 of 18 intracardiac shunts were identified on MRI, and all 8 hemodynamically significant shunts were quantitatively confirmed. The diagnosis of complete shunt closure or absent shunt was correctly made in all 6 cases. RV EF reduction was found in 6 of 24 patients. LV EF reduction was also found in 6 of 24 patients.
Flow measurements in Ao and Pu are more accurate than biventricular cine MRI for the assessment of Qp/Qs ratios. Flow measurements in Ao and Pu combined with biventricular cine MRI enables the quantification of hemodynamic significant shunts, higher grade VR and biventricular global systolic function with a single examination.
比较双心室容积测量与升主动脉（Ao）及肺动脉流出道（Pu）血流测量在定量心内分流方面的差异，并评估双心室电影磁共振成像（cine MRI）与血流测量相结合用于评估右心室（RV）和左心室（LV）心力衰竭及瓣膜反流（VR）的价值。
对24例患者，在Ao和Pu中进行右心室（RV）和左心室（LV）容积及血流测量，以评估RV每搏输出量（SV）与LV SV的比值，或分别评估肺SV与体循环主动脉SV的比值（Qp/Qs）。34例无超声心动图证实分流或VR的患者作为测量准确性的对照组。从RV和LV SV、Pu和Ao SV、Pu和LV SV以及RV和Ao SV计算左向右分流比值。左心室VR通过LV SV与Ao SV的差值计算，右心室VR通过RV SV与Pu SV的差值计算。通过双心室电影MRI评估整体收缩功能。
Qp/Qs > 1.16的心内分流可通过Ao和Pu中的血流测量进行定量。在无VR的情况下使用双心室容积测量，要求Qp/Qs > 1.21。18例心内分流中有17例在MRI上被识别，所有8例血流动力学显著分流均得到定量证实。在所有6例中均正确做出完全分流关闭或无分流的诊断。24例患者中有6例发现RV射血分数（EF）降低。24例患者中也有6例发现LV EF降低。
在评估Qp/Qs比值方面，Ao和Pu中的血流测量比双心室电影MRI更准确。Ao和Pu中的血流测量与双心室电影MRI相结合，能够通过单次检查对血流动力学显著分流、更高级别的VR及双心室整体收缩功能进行定量。
