Weber C, Dill T, Mommert I, Hofmann T, Adam G
Radiologische Klinik und Poliklinik, Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf, Germany.
Rofo. 2002 Nov;174(11):1387-94. doi: 10.1055/s-2002-35343.
Evaluation of morphologic and functional MRI of atrial septal defects (ASD) before and after percutaneous occlusion with the Amplatzer Septal Occluder (AOC). Comparison of MRI with transesophageal echocardiography (TEE), balloon measurement (IVBM) and cardiac catheterization with shunt quantification (CCSQ).
Twenty patients with ASD were examined before and three months after AOC implantation. ECG-triggered, breath-hold T1-weighted Turbo Spin Echo Segmented FLASH 2D and dynamic turbo-FLASH-GRE sequences after application of 0.2 mmol gadolinium DTPA per kg body weight were obtained in a 1.5 T MRI system. Defect size, and distance to coronal sinus (CS) and right upper pulmonary vein (RUPV) were determined for pre-interventional planning, and the AOC size was measured quantitatively for post-interventional follow-up. The shunts were evaluated qualitatively (occurrence of jets), semiquantitatively (jet length, turbulence square product) and quantitatively (flow measurement in the thoracic aorta and in the left and right pulmonary arteries).
The average size of the ASD measured by MRI was 17.6 mm (11 - 24.8 mm) in the axial view, 15.9 mm (10.8 - 28.9 mm) in the sagittal view and 16.4 mm (12.1 - 24.8 mm) in the short axis view. In comparison, the average defect size was 15 mm (8 - 24 mm) by TEE and 20 mm (13 - 27 mm) by IVBM. The average distance to the RUPV was 17 mm (9.6 - 21.9 mm) and to the CS 11.2 mm (5 - 17 mm). The AOC was visualized with only minimal artifacts. Qualitative analysis of the MRI findings revealed an occurrence of jets in 17/20 patients. Semiquantitative analysis documented a high correlation for jet length and square product of the turbulence to defect size r = 0.81 resp. r = 0.82. Mean QP/QS-ratio measured by MR-volumetry was 1.6 +/- 0.29 and by MR-flow 1.6 +/- 0.26. The corresponding measurements were 1.7 +/- 0.3 for TEE and 1.5 +/- 0.5 for CCSQ. In comparison to TEE, the correlation coefficient was r = 0.96 for MR-volumetry and r = 0.85 for MR-flow measurement.
MRI is found to be a valuable diagnostic method for pre-interventional planning and post-interventional follow-up of atrial septal defects occluded by the Amplatzer septal occluder.
评估经皮使用Amplatzer房间隔封堵器（AOC）封堵房间隔缺损（ASD）前后的形态学和功能磁共振成像（MRI）。将MRI与经食管超声心动图（TEE）、球囊测量（IVBM）以及用于分流定量的心脏导管检查（CCSQ）进行比较。
20例ASD患者在AOC植入前及植入后三个月接受检查。在1.5T MRI系统中，静脉注射每千克体重0.2mmol钆喷替酸葡甲胺后，采用心电图触发、屏气T1加权快速自旋回波分段FLASH 2D序列以及动态快速FLASH梯度回波序列。在介入治疗前规划时确定缺损大小、与冠状窦（CS）及右上肺静脉（RUPV）的距离，并在介入治疗后随访时定量测量AOC大小。对分流进行定性（有无血流束）、半定量（血流束长度、湍流平方积）和定量（胸主动脉及左右肺动脉血流测量）评估。
MRI测量的ASD平均大小在轴位为17.6mm（11 - 24.8mm），矢状位为15.9mm（10.8 - 28.9mm），短轴位为16.4mm（12.1 - 24.8mm）。相比之下，TEE测量的平均缺损大小为15mm（8 - 24mm），IVBM测量为20mm（13 - 27mm）。与RUPV的平均距离为17mm（9.6 - 21.9mm），与CS的平均距离为11.2mm（5 - 17mm）。AOC显示仅有轻微伪影。MRI检查结果的定性分析显示20例患者中有17例出现血流束。半定量分析表明血流束长度和湍流平方积与缺损大小高度相关，r分别为0.81和0.82。通过MR容积法测量的平均QP/QS比值为1.6±0.29，通过MR血流测量为1.6±0.26。TEE和CCSQ的相应测量值分别为1.7±0.3和1.5±0.5。与TEE相比，MR容积法的相关系数r = 0.96，MR血流测量的相关系数r = 0.85。
对于经Amplatzer房间隔封堵器封堵的房间隔缺损，MRI是介入治疗前规划和介入治疗后随访的一种有价值的诊断方法。
